CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI IMOLA 2829 OTTOBRE Dott
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28/29 OTTOBRE Dott. P. Riccio Ospedale S. Maria della Scaletta – Imola (BO) U. O. Chirurgia Generale – Dir. S. Artuso
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE • US: 2 Millions of laparotomies per year • Incisional hernia rate: 3 -20 % • 90000 ventral hernia annually • Factors associated with formation of incisional hernia: • WOUND INFECTION • IMMUNOSUPPRESSION • MORBID OBESITY • PREVIOUS OPERATION • PROSTATISM • SURGERY FOR ANEURYSMAL DISEASE • Abdominal wall defects are typically observed within the first 5 years
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE HERNIA REPAIR METHOD RECURRENCE PRIMARY REPAIR WITH SUTURE 41 -52 % HERNIORRHAPHIES WITH PROSTHETIC MESH. 12 -24% Required dissection of wide areas of soft tissue with increased incidence of wound infections and wound -related complications 15 %
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE MINIMALLY INVASIVE SURGERY: • SHORTER HOSPITAL STAY • IMPROVED PATIENTS OUTCOME • FEWER COMPLICATION
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE OUTCOMES Complications 112 (13. 2%) Recurrence 35 (4. 7%) Conversion to open technique 31 (4. 6%)
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE COMPLICATIONS
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE COMPLICATIONS
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE RECURRENCE
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE OUTCOMES 39 pt Complications 10 (25. 6%) Recurrence 3 (7. 7%) Conversion to open technique 1 (2. 5%) Operating time 161. 8 Hospital stay 5. 1
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE Recent experience of laparoscopic incisional and ventral hernia repair (LVIHR): good results give value to the procedure P. Riccio, G. Vetrone, S. Artuso Imola, 2005 – apr 2010
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE Patient Characteristics (147) Male/Female 51/96 Age (y) 61. 7 (15 -88) Body mass index 28. 8 (18 -45) ASA classification 2. 1 (1 -3) Previous open hernia repair 18 (12. 2%) Max diameter size (cm) 8. 4 (2 -28) Operating time (min) Postoperative hospital stay (d) Associated procedures 97. 5 (25 -240) 4. 8 (1 -27) 6 (5 laparoscopic cholecistectomy, 1 inguinal hernia)
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE Type of defect (1) Laparoscopic Incisional Hernia Repair - LIHR (111) Median laparotomies: 94 Lateral: 14 Left side 3 Mc Burney 2 Subcostal 8 Right Pararectal 1 Parastomal 3 Laparoscopic Ventral Hernia Repair - LVHR (36) Umbilical hernia 20 Epigastric hernia 16
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE Type of defect (2) ABDOMINAL BORDER (25) Subxiphoidal 4 Suprapubic 13 Subcostal 8 Type of defect (3) Chevrel classification Small (<= 5 cm) 32 (21. 8%) Medium (6 -9 cm) 51 (34. 7%) Large (=> 10 cm) 53 (36. 1) Type of defect (4) Swess-Cheese 26 (17. 6%)
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE Type of Prosthesis SEPRAMESH 7 (4. 8%) DYNA-MESH 5 (3. 4) PARIETEX 2 (1. 4) COMPOSIX 33 (22. 4%) PROCEED 97 (66%) PROLENE 3 (2%)
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE Type of fixation ABSORBABLE TACK 38 (25. 9%) NON ABSORBABLE TACK 109 (74. 1%)
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE OUTCOMES (147) Complications 25 (17%) Recurrence 10 (6. 8%) Conversion to open technique 4 (2. 7%) OUTCOMES (805 pt) Complications 112 (13. 2%) Recurrence 35 (4. 7%) Conversion to open technique 31 (4. 6%) Ann Surg 2003
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE COMPLICATIONS (19) Prolonged seroma (> 8 wk) 6 (4%) Prolonged ileus 6 (4%) Prolonged pain (> 6 months) 4 (2. 7%) Pulmunary Embolism 1 (0. 6%) Myocardial Infarction 1 (0. 6%) Pneumonia + wound infection 1 (0. 6%) Wound infection 1 (0. 6%) RE-OPERATION (5) Intestinal injury (2 ileus, 1 colon) 3 (2%) Postoperative bleeding 1 (0. 6%) Trocar site erniation 1 (0. 6%) TOTAL 25 (17%)
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE RECURRENCE 10 (6. 8%) Time to recurrence (days): 537 (31 -1517) Treatment of recurrence: Laparoscopic repair 2 Open repair 3 No repair 5 (small, asypmtomatic)
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE CONVERSION TO OPEN TECHNIQUE 4 (2. 7%) Severity of adhesions 3 (2%) Complete prosthesis detachment 1 (0. 6%)
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE YEAR N° BMI > 30 ASA 3 Age Chevrel >=10 Duration of surgery Post-operative hospital stay Complications Reoperation Conversion to open technique Recurrence 2005 30 15 (50%) 11 (36, 7%) 63, 8 13 (43, 3%) 110 5, 2 3 (10%) 1 (3. 3%) 1 (3. 5%) 4 (14%) 2006 32 6 (18, 8%) 8 (25%) 60, 1 5 (15, 5%) 87 5, 1 7 (21%) 2 (6%) 1 (3. 1%) 3 (9%) 2007 19 1 (5, 9%) 2 (10, 5%) 63, 1 6 (31, 5%) 98 4, 3 4 (21%) 1 (5%) 0 0 2008 24 14 (58, 3%) 11 (45, 8%) 65 13 (54, 2%) 99 4, 9 3 (12. 5%) 0 1 (4%) 3 (12. 5%) 2009 -2010 42 15 (35, 5%) 8 (19%) 58 16 (38%) 94 4, 4 8 (19%) 1 (2. 3%) 1 (3. 1%) 0 %
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE Complications (25) Incisional (111) 21 (19. 1) Ventral (36) 4 (11. 1) Year >= 2009 (42) 8 (19. 5) Year < 2009 (105) 17 (16. 2) BMI > =30 (51) 7 (14) BMI < 30 (83) 13 (15. 7) ASA 3 (40) 8 (20) P 0. 27 0. 632 0. 79 0. 5 Recurrence (10) 9 (8. 1%) 1 (2. 8%) 0 10 (9. 5%) 3 (5. 9%) 6 (7. 2%) 5 (12. 5%) P 0. 27 0. 038 0. 76 0. 1 Conversione (4) 3 (2. 7) 1 (2. 8) 1 (2. 4) 3 (2. 9) 2 (3. 9) 2 (2. 4) 0 ASA 1 -2 (112) 16 (15. 4) SWISS-CHEESE (26) 6 (24) No SWISS-CHEESE (121) 19 (15. 7) Previous repair (18) 1 (5. 9) No previous repair (129) 24 (18. 6) Chevrel large (53) 10 (19. 2) Chevrel smallmedium (94) 13 (15. 7) Abdominal border (25) 6 (24) NO abdominal border (122) 19 (15. 7) 8 (6. 6) 3 (2. 5) Fixation with absorbable tack (38) 6 (15. 8) 1 (2. 6) 0 Fixation with NON absorbable tack (109) 19 (17. 6) 5 (4. 8%) 2 (7. 7%) 0. 316 6 (6. 6%) 7 (5. 4) 0. 84 3 (3. 6) 0. 07 3 (2. 5) 3 (2. 3) 0. 07 2 (2. 4) 0. 7 0. 4 0. 66 0. 236 9 (8. 3) 0. 211 1 (4) 0. 79 0. 8 0618 2 (3. 8) 2 (8) 0. 31 0. 87 1 (5. 6) 6 (11. 3) 0. 59 0. 981 1 (3. 8) 3 (16. 7) 0. 19 4 (3. 8) P 0. 231 4 (3. 7)
CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28 -29 OTTOBRE Timing (min) Complications (25) 114 NO Complications (121) 94 No recurrence (137) 95 Recurrence (10) 120 NO Conversion (143) 95 Conversion (4) 157 Year >= 2009 (42) 94 Year < 2009 (105) 98 BMI > =30 (51) 107 BMI < 30 (83) 93 ASA 3 (40) 112 ASA 1 -2 (112) 92 No SWISS-CHEESE (121) 92 SWISS-CHEESE (26) 123 Previous repair (18) 106 No Previous repair (129) 96 Chevrel large (53) 115 Chevrel small-medium (94) 88 Abdominal border (25) 109 NO abdominal border (122) 95 P 0. 05 0. 07 0. 03 0. 6 0. 07 0. 01 0. 00 0. 3 0. 00 0. 09 Degenza postop (day) 7 4. 3 4. 8 4. 6 10. 5 4. 9 4. 4 5. 2 4. 7 5. 8 4. 4 4. 7 5. 4 4. 7 4. 8 5. 1 4. 6 5. 5 4. 6 P 0. 00 0. 9 0. 00 0. 4 0. 02 0. 3 0. 9 0. 4 0. 27 Max diameter defect size (cm) 8. 4 8. 3 8. 2 10. 2 8. 3 10. 5 8. 3 8. 7 8. 3 8. 9 8. 3 7. 6 11. 6 8. 3 8. 4 12. 3 5. 9 11 7. 8 P 0. 9 0. 09 0. 3 0. 8 0. 7 0. 9 0. 00 0. 8 0. 00
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