Abdominal wall reconstruction and complex-hernia repairs have advanced rapidly in recent years; it can be hard to keep up. Our own trainers and educators have seen the desire for more knowledge on these procedures. The techniques used in abdominal wall reconstruction and hernia repair, for example, have dominated our product-training Vista® courses.
Luckily, this year’s Americas Hernia Society had excellent panels that discussed differing techniques for abdominal wall reconstruction and complex-hernia repair. We made a list of four takeaways.
1. Hernia disease state and existing therapies
A strong understanding of the disease state, anatomy, and existing dissection techniques may be more important than the mesh. Mesh is still important, but some surgeons used to rely on mesh to do some heavy-lifting on the repair. Now, instead of finding the perfect mesh, surgeons are talking about the importance of other elements in the algorithm. Speaker Dr. William Hope shared a quote from Pronovost et al.
“One of the greatest opportunities to improve patient outcomes will probably come not from discovering new treatments but from more effective delivery of existing therapies.”1
2. Data and expertise collaboration
Data help surgeons make the right decisions and defend those decisions when they’re challenged. In today’s climate, regulatory bodies may question surgeons’ decisions. Tools like the Americas Hernia Society Quality Collaborative (AHSQC) let surgeons collect outcomes data and share those data with peers. “This is what happens when surgeons join together and share data for the greater good,” said Dr. Michael Rosen.
3. Hernia prevention
In hernia-repair procedures, the goal is to give the patient a definitive repair. In some cases, however, patients have a recurrence and enter, what some call, the vicious cycle of hernia repair. The likelihood of recurrence increases after each repair. Dr. Hope offered a suggestion: perform and document the proper ratio of suture length (SL) to wound length (WL). He shared a quote from Israelsson and Millbourn.
“The only way to ascertain that the wound is closed with an adequate SL to WL ratio is to always measure, calculate, and document the ratio at every midline incision.”2
4. Economics and efficiency
The economic impact of the hernia disease state is under ever-increasing scrutiny. As the number of patients who need treatment increases, so does the cost of treatment. Surgeons need to collaborate to find an economically productive treatment. “We must use a multi-pronged approach that includes optimized suturing, better repairs, and using preventative treatments,” said Dr. John Fischer.
Bonus: Human data on a hybrid hernia-repair reinforcement3
Dr. Andrew Strong presented a 63-patient trial of Zenapro® Hybrid Hernia Repair device. “We designed the trial to include multiple types of techniques and device placement because we wanted this to represent real-world hernia practice that surgeons face daily,” said Dr. Strong.
Take a look at some of the results of the Zenapro clinical study.
1. Pronovost PJ, Nolan T, Zeger S, et al. How can clinicians measure safety and quality in acute care? Lancet. 2004;363(9414):1061-1067.
2. Israelsson LA, Millbourn D. Prevention of incisional hernias: how to close a midline incision. Surg Clin North Am. 2013;93(5):1027-1040.
3. Strong A, El-Hayek K, Phillips M, et al. First human use of hybrid synthetic/biologic mesh in ventral hernia repair: 1 year results of a multicenter trial. Paper presented at: 18th Annual Hernia Repair Meeting of Americas Hernia Society; March 8, 2017; Cancun, Mexico.