Abdominal Wall Defects: Prevalence, Surgical Management Strategies and Clinical Care Outcomes


Jose J. Diaz, MD (Editor)
University of Maryland School of Medicine, Baltimore, MD, USA

Series: Congenital Disorders – Laboratory and Clinical Research
BISAC: MED047000

Since general surgeons first started performing laparotomies in the late 1880’s, acquired hernias and abdominal wall defects have become a surgical disease of their own. Many surgeons have made it their life’s work to develop surgical techniques, design hernia meshes or utilize biologic tissue for repair of these abdominal wall defects. Hernias are defined as a defect in the normal architecture of the abdominal wall muscuolo-aponeuroic structure. They are subdivided into congenital or acquired hernias. The ventral or incisional hernia defects are rare due to the failure of normal healing of the incision after a laparotomy.

The approach to the initial repair may be quite straightforward in the patient with a simple fascial defect who is otherwise healthy. As the size of the defect gets beyond 4 cm, or the patient has a significant co-morbid disease, other considerations must come into play. One must optimize the patient’s co-morbidities, and the selection of the operative technique must become more complicated.

Today, the decisions of which operative technique to utilize are based on the etiology of the hernia, the number of previous repairs, the co-morbidities of the patient, the size of the defect, and lastly, the skill set of the surgeon. As a newer biologic mesh has come onto the market and the common use of the open abdomen in trauma and emergency surgery, surgical techniques which were once performed only by plastic surgeons, are now commonly used by general surgeons. The component separation technique for abdominal wall reconstruction has brought many new young surgeons to focus their skills toward improving it.

With the advances in critical care and peri-operative resuscitation together with knowledge of the abdominal compartment syndrome, surgeons are addressing very complicated ventral hernias. They commonly have significant loss of domain, tissue loss due to infection or tumor, or an entero-atmospheric intestinal fistula. The combined information in this text will help the surgeon identify the right surgical technique for the right patient.

The focus of the text is the evaluation, prevalence, surgical techniques, and outcomes of patients undergoing complex ventral hernia repairs. The use of preoperative evaluation imaging is reviewed. The multiple etiologies of hernia and abdominal wall defects are mentioned. The surgical repairs utilizing tissue repairs, both synthetic and biologic mesh are reviewed, and the component separation is discussed in detail. New endo/laparoscopic component separation techniques are also described. This text will become a must-have for every surgeon who takes care of patients with complex ventral hernias. (Imprint: Nova Biomedical )

Table of Contents

Table of Contents



Chapter 1. Incisional Hernia: Incidence, Risk Factors, Prevention, and Future Directions
(William W. Hope, Khoi Le and W. Borden Hooks III, South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina, USA)

Chapter 2. Diagnostic Assessment of Ventral Hernia
(Rebeccah B. Baucom and Benjamin K. Poulose, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA)

Chapter 3. Comorbidities and Ventral Hernia Repair
(Margaret H. Lauerman, Ronald Tesoriero and Jose J. Diaz, Program In Trauma, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA)

Chapter 4. The Burden of the Open Abdomen
(Aude Vanlander and Frederik Berrevoet, Department of General and Hepatobiliary Surgery, Liver Transplantation Service, University Hospital Ghent, Ghent, Belgium)

Chapter 5. The Management of Abdominal Wall Desmoid Tumors: Current Concepts and Surgical Strategy
(Emilio Bertani, Carlo Corbellini, Antonio Chiappa, Roberto Biffi and Bruno Andreoni, Department of General Surgery, European Institute of Oncology, Via Ripamonti, Milan, Italy

Chapter 6. Risk of Abdominal Compartment Syndrome Despite Application of a Silo in Newborns Suffering from Abdominal Wall Defects
(Johannes Mayr, Department of Pediatric Surgery, University Children’s Hospital Basel, Switzerland)

Surgical Management Strategies

Chapter 7. Paraostomy Hernias: Prevention and Prosthetic Mesh Repair
(Paul H. Sugarbaker, Washington Cancer Institute, Washington, DC, USA)

Chapter 8. Complex Abdominal Wall Reconstruction: Using Autologous Tissue Flaps
(Gloria R. Sue and Deepak Narayan, Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA)

Chapter 9. Reconstruction of Severely Infected Abdominal Walls Using Latissimus Dorsi Free Flaps
(Sang Wha Kim, Jeong Tae Kim and Youn Hwan Kim, Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea and others)

Chapter 10. Abdominal Wall Reconstruction: Biomaterials and Tissue Engineering Biomaterials
(Alex Pontini, Giorgio Giatsidis, Erica Dalla Venezia, Frederica Miglietta and Cesare Tiengo, Clinic of Plastic Surgery, Padova University Hospital, Padova, Italy)

Chapter 11. Abdominal Wall Repair Post-Hernia in Kidney and Liver Transplantation and after a Gun Shot Wound
(Alberto Di Giuseppe, Andrea Vecchi, Elisabetta Petrucci, Elisa Bolletta and Marco Vivarelli, Department of Plastic and Reconstructive Surgery, University of Ancona, Italy)

Chapter 12. Inguinal Hernia Repair: Current Techniques
(J.M. Suárez-Grau, J.A. Bellido Luque and J.L. García Moreno, General Hospital of Riotinto, Huelva, Spain)

Chapter 13. Management of Ventral Hernia and of Postoperative Abdominal Wall Defects with Vacuum-Assisted Closure Therapy
(Isabel Galindo-Benito, Jaime Ruiz-Tovar, Pedro García-Peche, Antonio Arroyo-Sebastián and Rafael Calpena-Rico, General University Hospital Elche, Alicante, Spain)

Chapter 14. Abdominal Wall Reconstruction after Necrotizing Soft Tissue Infections with Tissue Loss
(Jonathan Zelken, Arif Chaudhry and Eduardo Rodriguez, Division of Plastic Surgery, Johns Hopkins Hospital and the University of Maryland/Shock Trauma Center, Baltimore, Maryland, USA)

Chapter 15. Endoscopic Component Separation
(Saïd Charbel Azoury and Hien T. Nguyen, Johns Hopkins Hospital, Baltimore, Maryland, USA)

Chapter 16. Minimally Invasive Component Separation
(Kristin C. Turza and Charles E. Butler, Department of Plastic Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA)

Clinical Care Outcomes

Chapter 17. Complex Abdominal Wall Reconstruction: Comparing Primary Closure and Biologic and Synthetic Meshes
(John A.M. Paro, Deepak M. Gupta, Eric J. Wright, Gordon K. Lee, Department of Plastic Surgery, Stanford University, California, USA)

Chapter 18. Biologic Mesh in the Infected Field
(Margaret H. Lauerman, Ronald Tesoriero and Jose J. Diaz, Program In Trauma, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA)

Chapter 19. Surgical Site Infection after Ventral Hernia Repair with Synthetic Mesh
(Katherine G. Lamond and Jonathan P. Pearl, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA)


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