Innovations in Abdominal Wall Reconstruction · 2019. 5. 13. · Innovations in Abdominal Wall...
Transcript of Innovations in Abdominal Wall Reconstruction · 2019. 5. 13. · Innovations in Abdominal Wall...
Innovations in Abdominal Wall
Reconstruction
Ajita S. Prabhu MD, FACS
Assistant Professor of Surgery
Cleveland Clinic Center for Abdominal Core
Health
Cleveland Clinic Foundation
Cleveland Ohio
Disclosures
• Research Support
- Intuitive
• Speaker
- Intuitive
• Consultant
- Bard Davol
- Medtronic
2. Component Separation
Techniques
Ramirez OM, et al. PRS. 1990
Component Separation
Ramirez OM, et al. PRS. 1990
• Rectus Muscle
- Upper 3 cm
- Middle 5 cm
- Lower 3 cm
• External Oblique
- Upper 2 cm
- Middle 4 cm
- Lower 2 cm
Open Component
Separation
Anterior Approach
Understand the Anatomy
Rosen MJ. Atlas of Abdominal Wall Reconstruction. 2015
1. Component Separation
Techniques
• Component separation can allow us to
get soft tissue coverage over the mesh,
reapproximate the midline, and often
restore the function and even contour
of the abdominal wall.
• * A word of caution: care should be
taken when selecting appropriate
candidates
2. Hernia Classification
Systems
VHWG
VHWG, Surgery 2010
Modified VHWG
Kanters et al, JACS 2012
EHS Classification
Muysoms et al, Hernia 2012
Petro Staging Systems for
Hernias
Petro, et al. Hernia, 2016
2. Hernia Classification
Systems
• Still poorly adopted, however gaining
momentum over time
• Only when we speak the same
language can we begin to understand
the best way to treat the disease
3. Robotic AWR
3. Robotic AWR
• May allow us to offer the same
operation that we often do open with a
potentially better recovery
• Still early to know, need more data
4. Collaboration
4. Collaboration
• 51 year old patient
• Bladder exstrophy
• Ileal conduit
• Multiple failed
hernia repairs
• Biliary colic
• Desired continent
conduit and
cholecystectomy
5. Multidisciplinary Care
5. Multidisciplinary Care
• Care can be taken
to the next level
when we
communicate and
collaborate across
specialties
6. Abdominal Core Health
6. Abdominal Core Health
• Abdominal wall reconstruction is much
more than just surgery
• The time has come to shift our
paradigm
Conclusions
• Hernia surgery and Abdominal Wall
Reconstruction have come a long way
• We are just scratching the surface
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