Eighth international congress of the ASIA-PACIFIC HERNIA SOCIETY CEBU 10-12 OCTOBER 2012 CEBU 10-12 OCTOBER 2012 The third way to treat Groin hernias:

Eighth international congress of theEighth international congress of the

ASIA-PACIFIC HERNIA SOCIETYASIA-PACIFIC HERNIA SOCIETY

CEBU 10-12 OCTOBER 2012CEBU 10-12 OCTOBER 2012

The third way to treat Groin hernias:The third way to treat Groin hernias:

The Minimal Open Preperitoneal approachThe Minimal Open Preperitoneal approach

(minimal access and minimal invasive!)(minimal access and minimal invasive!)

Marc Soler, Cagnes sur Mer – FranceMarc Soler, Cagnes sur Mer – France

the three surgical way the three surgical way for groin hernia repair for groin hernia repair

with prothesis with prothesis

Open surgery Open surgery

Coeliscopic surgeryCoeliscopic surgery

The third way: posterior open, The third way: posterior open, minimalminimal

access, and minimal invasive access, and minimal invasive approachapproach

The Nyhus The Nyhus Preperitoneal Preperitoneal

Repair, 1955-1960Repair, 1955-1960

The Nyhus Preperitoneal The Nyhus Preperitoneal RepairRepair

The Nyhus Preperitoneal The Nyhus Preperitoneal RepairRepair

Henri R Fruchaud, 1956Henri R Fruchaud, 1956

The surgical treatment of The surgical treatment of inguinal or femoral hernias inguinal or femoral hernias must not be the closure of must not be the closure of the inguinal canal or the the inguinal canal or the femoral ring, but the « deep femoral ring, but the « deep reconstruction » of the reconstruction » of the abdominal wall in the whole abdominal wall in the whole groin regiongroin region

Surgical Anatomie of groin herniaSurgical treatment of groin hernia

JEANJEAN RivesRives

19651965

René StoppaRené Stoppa

Giant prosthetic reinforcement of the viscéral sac Giant prosthetic reinforcement of the viscéral sac 1967: First tension free and sutureless hernia repair1967: First tension free and sutureless hernia repair

GEORGES GEORGES WANTZWANTZ

Unilateral GPRVS for the treatment of complex Unilateral GPRVS for the treatment of complex herniashernias

Ambulatory, local anesthesiaAmbulatory, local anesthesia

Laparoscopic Laparoscopic hernia surgeryhernia surgery

19921992

Transperitoneal approachTransperitoneal approach

J. Leroy, G. Fromont J. Leroy, G. Fromont

Properitoneal approachProperitoneal approach

G. Begin, JL DulucqG. Begin, JL Dulucq

J.H. J.H. ALEXANDREALEXANDRE

19811981-- INGUINAL APPROACH INGUINAL APPROACH

-CORD -CORD PARIETALISATION PARIETALISATION

- M. P. O. OVERLAPPING- M. P. O. OVERLAPPING

Franz UgaharyFranz Ugahary19951995

Preperitoneal cleavage Preperitoneal cleavage inferior inferior epigastric vessels – medial hernia – cord structuresepigastric vessels – medial hernia – cord structures

Insertion of the meshInsertion of the mesh

Regular flat meshRegular flat mesh

New prosthesisNew prosthesis

SPECIFIC MATERIALSPECIFIC MATERIAL

SPECIFIC MATERIALSPECIFIC MATERIAL

TIPP TECHNIQUETIPP TECHNIQUEE. PélissierE. Pélissier

Hernia , 2006Hernia , 2006

TIPP TIPP TECHNIQUETECHNIQUE

Berrevoet 2009Berrevoet 2009

UGAHARY (Grid Iron)UGAHARY (Grid Iron)

TIPP TECHNIQUE 2005TIPP TECHNIQUE 2005

6. Berrevoët et al. Hernia. 2009

scrotal « approach »

TIPP TECHNIQUETIPP TECHNIQUEJ.F. GillionJ.F. Gillion

TIPP TECHNIQUETIPP TECHNIQUEPREPERITONEALE DISSECTIONPREPERITONEALE DISSECTION

PARIETALISATIONPARIETALISATIONJ.F. GillionJ.F. Gillion

TIPP TECHNIQUETIPP TECHNIQUEJ.F. GILLIONJ.F. GILLION

Marc Soler: Cagnes sur merMarc Soler: Cagnes sur mer

From March 2001 To September 2011 From March 2001 To September 2011 N =1575 (1358 patients) N =1575 (1358 patients)

March 2001 TO february 2009: March 2001 TO february 2009:

-regular flat mesh, and Light weight -regular flat mesh, and Light weight meshes: 1375 casesmeshes: 1375 cases

UGAHARY (GRID IRON)UGAHARY (GRID IRON)

Marc Soler Cagnes sur merMarc Soler Cagnes sur mer

February 2009 TO September 2011: February 2009 TO September 2011: New expandable mesh: 200 casesNew expandable mesh: 200 cases

(Ugahary technique, Grid Iron)(Ugahary technique, Grid Iron)

Marc Soler Cagnes sur MerMarc Soler Cagnes sur MerSEPTEMBER 2011-MARCH 2012SEPTEMBER 2011-MARCH 2012

TIPP TECHNIQUE AND GRID IRONTIPP TECHNIQUE AND GRID IRON100 CASES100 CASES

WITH THE NEW LESS RIGID MESHWITH THE NEW LESS RIGID MESH

Marc Soler: Cagnes sur mer Marc Soler: Cagnes sur mer

FIST 300 HERNIAS (263 PATIENTS) 2001 – 2004FIST 300 HERNIAS (263 PATIENTS) 2001 – 2004

Mean follow up: 18 monthsMean follow up: 18 months Rate of follow up: 85%Rate of follow up: 85% 223 MEN, 40 WOMEN223 MEN, 40 WOMEN PRIMARY: 284; SECONDARY: 16PRIMARY: 284; SECONDARY: 16 ANESTHESIAANESTHESIA

GENERAL: 9 (3,4%)GENERAL: 9 (3,4%) SPINAL: 172 (63,4%SPINAL: 172 (63,4%

ILIO INGUINAL BLOCK : 82 ILIO INGUINAL BLOCK : 82 (32,2%)(32,2%)

e-mémoires de l'Académie Nationale de Chirurgie, 2004, 3 (3) : 28-33e-mémoires de l'Académie Nationale de Chirurgie, 2004, 3 (3) : 28-33

HOSPITAL STAYHOSPITAL STAY DAY SURGERY: 128 ( 48,3%)DAY SURGERY: 128 ( 48,3%) Less than 48 hours: 123 (46,6%)Less than 48 hours: 123 (46,6%) More than 48 hours 14 (5%)More than 48 hours 14 (5%)

COMPLICATIONSCOMPLICATIONS

Haematoma: 12Haematoma: 12

Infection: 0Infection: 0



FIST 300 HERNIAS (263 PATIENTS)FIST 300 HERNIAS (263 PATIENTS) 2001 - 2004 2001 - 2004


FIST 300 HERNIAS (263 PATIENTS)FIST 300 HERNIAS (263 PATIENTS) 2001 - 2004 2001 - 2004

RECURRENCE: 7 (2,3%)RECURRENCE: 7 (2,3%)

PAINPAINDiscomfort: N=8Discomfort: N=8

Odd sensation: N=15Odd sensation: N=15

Severe Pain: 1 finish after 6 monthsSevere Pain: 1 finish after 6 months


Marc Soler: Cagnes sur mer Marc Soler: Cagnes sur mer NEW EXPANDABLE PROTHESISNEW EXPANDABLE PROTHESIS

2009-20102009-2010200 HERNIAS-183 PATIENTS200 HERNIAS-183 PATIENTS

MEANS FOLLOW UP: 18 monthsMEANS FOLLOW UP: 18 months RATE OF FOLLOW UP: 87%RATE OF FOLLOW UP: 87% 175 MEN, 8 WOMEN175 MEN, 8 WOMEN PRIMARY: 184; SECONDARY: 16PRIMARY: 184; SECONDARY: 16 ANESTHESIAANESTHESIA

GENERAL: 0GENERAL: 0 SPINAL: 97(48,5%)SPINAL: 97(48,5%) ILIO INGUINAL BLOCK: 103 (51,5%)ILIO INGUINAL BLOCK: 103 (51,5%)


NEW EXPANDABLE NEW EXPANDABLE PROTHESISPROTHESIS2009-20102009-2010

200 HERNIAS-183 PATIENTS200 HERNIAS-183 PATIENTS HOSPITAL STAY: HOSPITAL STAY: DAY SURGERY 182 (91%)DAY SURGERY 182 (91%) ONE NIGHT OR MORE: 18 (9%)ONE NIGHT OR MORE: 18 (9%)


Superficial haematoma or seroma: 9Superficial haematoma or seroma: 9


Bladder retention: 2Bladder retention: 2

NEW EXPANDABLE PROTHESISNEW EXPANDABLE PROTHESIS2009-20102009-2010

200 HERNIAS-183 PATIENTS200 HERNIAS-183 PATIENTS

Reccurence N=2 ( 1%): small and Reccurence N=2 ( 1%): small and asymptomaticasymptomatic

DiscomfortDiscomfort Discomfort with normal activity: 23Discomfort with normal activity: 23 Difficulty with sport: 1Difficulty with sport: 1

Moderate painModerate pain with normal activity: 3with normal activity: 3 Difficulty with sport: 1Difficulty with sport: 1 Necessity to stop hard work: 1Necessity to stop hard work: 1

Necessity to have pain killer: 0Necessity to have pain killer: 0

VA SCALEVA SCALE VAS DURING DAILY ACTIVITYVAS DURING DAILY ACTIVITY

VAS=0: 150 VAS=0: 150 VAS=4: 3VAS=4: 3 VAS=1: 7VAS=1: 7 VAS=5: 3VAS=5: 3 VAS=2: 1VAS=2: 1 VAS=7: 1VAS=7: 1 VAS=3: 5VAS=3: 5 VAS=8: 1VAS=8: 1

For all the patient the pain is always For all the patient the pain is always less than the preoperative oneless than the preoperative one

NEW EXPANDABLE PROTHESISNEW EXPANDABLE PROTHESIS200 HERNIAS-183 PATIENTS200 HERNIAS-183 PATIENTS

Marc Soler: Cagnes sur mer Marc Soler: Cagnes sur mer NEW SEMI RIGID PROTHESISNEW SEMI RIGID PROTHESIS

2011-20122011-2012100 HERNIAS-91 PATIENTS100 HERNIAS-91 PATIENTS

FOLLOW UP: 6 monthsFOLLOW UP: 6 months RATE OF FOLLOW UP: 100%RATE OF FOLLOW UP: 100% 92 MEN, 8 WOMEN92 MEN, 8 WOMEN PRIMARY: 92; SECONDARY: 8PRIMARY: 92; SECONDARY: 8 ANESTHESIAANESTHESIA

GENERAL: with laryngeal mask without GENERAL: with laryngeal mask without curarization: 42curarization: 42

SPINAL: 3SPINAL: 3 ILIO INGUINAL BLOCK: 55 ILIO INGUINAL BLOCK: 55


NEW EXPANDABLE NEW EXPANDABLE PROTHESISPROTHESIS2011-20122011-2012

100 HERNIAS-92 PATIENTS100 HERNIAS-92 PATIENTS HOSPITAL STAY: HOSPITAL STAY:

DAY SURGERY 91 (91%)DAY SURGERY 91 (91%) ONE NIGHT OR MORE: 9 (9%)ONE NIGHT OR MORE: 9 (9%)


Superficial haematoma or seroma: 4Superficial haematoma or seroma: 4


Bladder retention: 0Bladder retention: 0

NEW EXPANDABLE PROTHESISNEW EXPANDABLE PROTHESIS2011-20122011-2012

100 HERNIAS-92 PATIENTS100 HERNIAS-92 PATIENTS

Reccurence N=0 Reccurence N=0

DiscomfortDiscomfort Discomfort with normal activity: 12Discomfort with normal activity: 12 Difficulty with sport: 1Difficulty with sport: 1

Moderate painModerate pain with normal activity: 1with normal activity: 1 Difficulty with sport: 1Difficulty with sport: 1 Necessity to stop hard work: 1Necessity to stop hard work: 1

Necessity to have pain killer: 0Necessity to have pain killer: 0

VA SCALEVA SCALE VAS DURING DAILY ACTIVITYVAS DURING DAILY ACTIVITY

VAS=0: 85 VAS=0: 85 VAS=4: 1VAS=4: 1 VAS=1: 8VAS=1: 8 VAS=5: 2VAS=5: 2 VAS=2: 1VAS=2: 1 VAS=3: 2VAS=3: 2

For all the patient, the pain is always For all the patient, the pain is always less than the preoperative oneless than the preoperative one

NEW EXPANDABLE PROTHESISNEW EXPANDABLE PROTHESIS100 HERNIAS-92 PATIENTS100 HERNIAS-92 PATIENTS

MOPP TECHNIQUE MOPP TECHNIQUE ConclusionConclusion

UGAHARY (GRID IRON TECHNIQUE)UGAHARY (GRID IRON TECHNIQUE)

TIPP ( Trans Inguinale PrePeritoneale TIPP ( Trans Inguinale PrePeritoneale technique)technique)

MOPP TECHNIQUEMOPP TECHNIQUEConclusionConclusion

Total groin hernia repair primary & Total groin hernia repair primary & secondary herniasecondary hernia

Minimal invasiveMinimal invasive Minimal accessMinimal access Local anesthesia, general anesthesia with tracheal Local anesthesia, general anesthesia with tracheal

mask without curarizationmask without curarization Complication Complication no conversion no conversion

MOPP TECHNIQUEMOPP TECHNIQUEConclusionConclusion

Surgical TechniqueSurgical Technique

No nerves dissectionNo nerves dissection

No prosthesis on the contact of the No prosthesis on the contact of the nervesnerves

We never fix the prosthesisWe never fix the prosthesis

MOPP TECHNIQUEMOPP TECHNIQUEConclusion Conclusion

The use of the new less rigid meshThe use of the new less rigid mesh

Make easier to unroll the prosthesis in the Make easier to unroll the prosthesis in the

Preperitoneal space.Preperitoneal space.

PROSPECTIVE STUDY PROSPECTIVE STUDY

- Post operative pain/ QOL- Post operative pain/ QOL- recurrence rate- recurrence rate

Documents

Eighth international congress of the ASIA-PACIFIC HERNIA SOCIETY CEBU 10-12 OCTOBER 2012 CEBU 10-12 OCTOBER 2012 The third way to treat Groin hernias: