Abdominal Wall Reconstruction, An Issue of Surgical Clinics, by Michael J. Rosen MD FACS

By Michael J. Rosen MD FACS

A massive evaluate on belly wall reconstruction for the final doctor! issues will contain preoperative optimization of a ventral hernia sufferer, prevention of incisional hernias, laparoscopic ventral hernia fix, open ventral hernia fix, bizarre hernias, epigastric and umbilical hernias, parastomal hernia fix, flap reconstruction, artificial mesh, medical results of biologic mesh, pediatric hernias, takedown of enterocutaneous fistula, a evaluation of laparoscopic as opposed to open inguinal hernia, and extra!

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Additional resources for Abdominal Wall Reconstruction, An Issue of Surgical Clinics, 1e (The Clinics: Surgery)

Example text

With the growing pressures to provide excellent care in a cost-effective manner, the economics of abdominal wall reconstruction is critically evaluated. With ventral hernias being one of the most common procedures performed by general surgeons, the financial implications of many of our decisions is now coming under careful scrutiny. It is important for all surgeons to understand the financial impact on the decisions they make in the operating room, to both improve patients' outcomes and provide cost effective care.

1 Box 3 Recommendations on how to close a midline incision to minimize the rate of incisional hernia Use a slowly absorbable or nonabsorbable suture material Use a suture USP 2/0 mounted on a small needle Place stitches: In the aponeurosis only 5 to 8 mm from the wound edge 4 to 5 mm apart Measure the wound length and the suture remnants for calculation of the SL to WL ratio Document the SL to WL ratio Do not accept closure with an SL to WL ratio lower than 4 A high SL to WL ratio can be accomplished with large stitches or with small stitches placed at closer intervals.

I have met very few senior surgeons who would not admit privately if not publicly that they never felt like they began to understand hernia repairs until they were a senior resident. Furthermore, most will admit that until they had performed a fair number as a staff surgeon they had not established a comfort level with the procedures. ” As always, the best way to shorten the learning curve and to minimize the likelihood of creating potentially avoidable complications is to start by learning what others have learned.

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