Hernia Repair Sequelae

Synopsis
Even the best hernia repair can result in postoperative difficulties for the patient caused by repair sequelae as for
example pain, infertility, infection, adhesion and dislocation of the protheses. That can happen many years later and
now, where the general principle of hernia repair is well understood all over the world, these sequelae are noticed
more and more. To define them, to evaluate the absolute and relative risk of these sequelaes and to describe the ways
of their prevention, diagnosis and treatment, the 5th Suvretta meeting had focussed on this subject. We discussed if
there’s a principle risk by technique, material or both. The results of these discussions and the future handling and
evaluation of this problem was the aim of this meeting. Even the best method can be made better by optimization of its
single components.

Even the best hernia repair can result in postoperative difficulties for the patient caused by repair sequelae such as
pain, infertility, infection, adhesion and dislocation of the prostheses. This can happen many years later, and now
that the general principle of hernia repair is broadly understood all over the world, these sequelae are being noticed
more and more. The 5th Suvretta meeting was held in order to define these sequelae, to evaluate the absolute and
relative risks they pose, and to discuss the methods of their prevention, diagnosis and treatment. We discussed whether
the principal risk was related to technique, material or both. This discussion and the future approach to and
evaluation of this problem were the aims of the meeting, working on the premise that even the best method can be made
better by optimizing its individual components.


Table of Contents
I Risk for the Spermatic Cord
1 Are There Adverse Effects of Herniorrhaphy
Techniques on Testicular Perfusion? . . . . . . . . . . 3
2 The Effects of Mesh Bioprosthesis
on the Spermatic Cord Structures in a
Rat Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3 Damage to the Spermatic Cord by the
Lichtenstein Procedure in a Pig Model?
Preliminary Results . . . . . . . . . . . . . . . . . . . . . . . . . . 21
4 Influence of Prosthetic Implants on Male
Fertility in Rabbits and Rats . . . . . . . . . . . . . . . . . 29
5 The Effects of a Mesh Bioprosthesis on
the Spermatic Cord Structures . . . . . . . . . . . . . . 39
6 Influence of Prosthetic Implants on Male
Fertility in Rats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
7 What Can We Do To Decrease the Risk
of Vas Deferens Injury due to Inguinal
Hernioplasty? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
8 The Long-Term Effect on Testicular
Function of a Mesh Bioprosthesis Used for
Inguinal Hernia Repair . . . . . . . . . . . . . . . . . . . . . . 57
9 Reoperation Following Lichtenstein Repair:
What Do Vas and Nerves Look Like? . . . . . . . . . 65
10 Damage to the Spermatic Cord from
Groin Herniorrhaphy: A Review . . . . . . . . . . . . . . 71
II Risk for Infection
11 Mesh Infection Following Hernia Repair:
A Frequent Problem? . . . . . . . . . . . . . . . . . . . . . . . 79
12 Patient Factors as a Major Determinant
of Wound Outcome and Infection After
Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
13 Mesh-Related Infections After Hernia
Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
14 Human Acellular Dermal Matrix for
Ventral Hernia Repair in the Compromised
Surgical Field . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103
15 Fate of the Inguinal Hernia Following
Removal of Infected Prosthetic Mesh . . . . . . .113
16 Mesh Infection뻋herapeutic Options . . . . . . .119
17 Does Antibiotic Prophylaxis Prevent the
Occurrence of Wound Infection After Groin
Hernia Surgery? . . . . . . . . . . . . . . . . . . . . . . . . . . . .125
18 Infection Control in a Hernia Clinic:
24-Year Results of Aseptic and Antiseptic
Measure Implementation in 4,620 틽lean
Cases?Based on Up-To-Date Microbiological
Research . . . . . . . . . . . . . . . . . . . . . . . .135
19 Components Separation Technique:
Pros and Cons . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143
III Risk for Pain
20 Self-Assessment of Discomfort and Pain
after Inguinal Hernia Repair: A Reflection
of Both Individual Pain Propensity and
Surgical Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . .155
21 Chronic Pain After Inguinal Hernia Repair . . .163
22 What Do We Know About the Pathophysiology
and Pathology of Neuropathic
Pain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169
23 Surgical Trauma of Nerves뺺auses of
Neuropathic Pain, Classification, and
Options in Surgical Therapy . . . . . . . . . . . . . . . .177
24 Risks for Pain뻅europathic Pain:
How Should We Handle the Nerves? . . . . . . . .185
25 What To Consider as Clinicians About
Chronic Postoperative Pain and Inguinal
Herniorrhaphy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191
26 Risk Factors for Chronic Pain After
Groin Hernia Surgery . . . . . . . . . . . . . . . . . . . . . .199
27 Ischemic Inflammatory Response
Syndrome as an Alternative Explanation
for Postherniorrhaphy Pain . . . . . . . . . . . . . . . . .207
28 Postoperative CRPS in Inguinal Hernia
Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213
29 Chronic Pain After Open Mesh Repair
of Incisional Hernia . . . . . . . . . . . . . . . . . . . . . . . .221
XII Contents
30 Clinical Results After Open Mesh Repair . . . .227
31 Acute and Chronic Pain After Laparoscopic
Incisional Hernia Repair . . . . . . . . . . . . . . . . . . . .233
32 Effect of Nerve Identification on the Rate
of Postoperative Chronic Pain Following
Inguinal Hernia Surgery . . . . . . . . . . . . . . . . . . . .239
33 Discomfort 5 Years After Laparoscopic
and Shouldice Inguinal Hernia Repair:
A Report from the SMIL Study Group . . . . . . .245
34 Recurrence or Complication: The Lesser
of Two Evils? A Review of Patient-Reported
Outcomes from the VA Hernia Trial . . . . . . . . .251
35 Chronic Pain After Inguinal Hernia
Repair: The Choice of Prosthesis
Outweighs That of Technique . . . . . . . . . . . . . .257
36 The Effect of Polypropylene Mesh on
the Ilioinguinal Nerve in Open Mesh
Repair of Groin Hernia . . . . . . . . . . . . . . . . . . . . .265
37 Lightweight Macroporous Mesh vs.
Standard Polypropylene Mesh in
Lichtenstein Hernioplasty . . . . . . . . . . . . . . . . . .275
38 Does the Choice of Prosthetic Mesh Type
Make a Difference in Postherniorrhaphy
Groin Pain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .279
39 New Understanding of the Causes and
Surgical Treatment of Postherniorrhaphy
Inguinodynia and Orchialgia . . . . . . . . . . . . . . .287
40 Surgery for Chronic Inguinal Pain:
Neurectomy, Mesh Explantation, or Both? . . . 293
41 Results of Tailored Therapy for Patients
with Chronic Inguinal Pain . . . . . . . . . . . . . . . . .299
IV Risk for Adhesion
42 Adhesion as a Chronic Inflammatory
Problem? Risk for Adhesions, Migration,
and Erosions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .305
43 Biological Tissue Graft: Present Status . . . . . .317
44 IPOM Results of 344 Consecutive Patients
with a PVDF-Derived Prosthesis . . . . . . . . . . . . . 323
45 Pooled Data Analysis of Laparoscopic vs.
Open Ventral Hernia Repair: 14 Years of
Patient Data Accrual . . . . . . . . . . . . . . . . . . . . . . .331
46 Tissue Ingrowth, Adhesion, and Mesh
Contraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .345
47 Effect of Different Mesh Materials on
Adhesion Formation . . . . . . . . . . . . . . . . . . . . . . .353
48 Tissue Ingrowth and Laparoscopic
Ventral Hernia Mesh Materials: An Updated
Review of the Literature . . . . . . . . . . . . . . . . . . . .365
49 Porosity and Adhesion in an IPOM
Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .375
50 Benefit of Lightweight and/or Titanium
Meshes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .381
51 ePTFE Prostheses and Modifications . . . . . . . .393
52 The Role of Stem Cells in Abdominal
Wall Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .401
V Risk for Migration and
Erosion
53 Safety and Durability of Prosthetic Repair
of the Hiatal Hernia: Lessons Learned from
a 15-Year Experience . . . . . . . . . . . . . . . . . . . . . . .413
54 Mesh Migration into the Esophageal
Wall After Mesh Hiatoplasty . . . . . . . . . . . . . . . .421
55 Complications After Gastric Banding?
Results in Germany . . . . . . . . . . . . . . . . . . . . . . . .429
56 Alloplastic Implants for the Treatment
of Stress Urinary Incontinence and Pelvic
Organ Prolapse . . . . . . . . . . . . . . . . . . . . . . . . . . . .439
57 Prophylactic IPOM Mesh To Prevent
Parastomal Hernias . . . . . . . . . . . . . . . . . . . . . . . .445
58 Laparoscopic Parastomal Hernia Repair:
Pitfalls and Complications . . . . . . . . . . . . . . . . . .451
59 Concept of Visible Mesh and Possibilities
for Analysis of Mesh Migration and
Shrinkage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .457
VI Strategy to Improve Results
60 Who Has the Major Role in Hernia Surgery:
The Surgeon or the Material? . . . . . . . . . . . . . . .463
61 Two Controversial Concepts: Standard
Procedure in a Standard Patient Versus
Tailored Surgery with Procedures Adjusted
to Individual Patients . . . . . . . . . . . . . . . . . . . . . .467
XIII
Contents
VII Pro and Contra
62 In Support of a Standard Technique for
Inguinal Hernia Repair . . . . . . . . . . . . . . . . . . . . .475
63 In Support of Individual Selection of
Technique as Related to the Patient?
Improvement by Better Selection of
Patients Who Can Be Offered a Less Risky
Technique: Groin Hernia . . . . . . . . . . . . . . . . . . .479
64 In Support of Standard Procedure in
Abdominal Hernia Repair . . . . . . . . . . . . . . . . . .485
65 In Support of Individualized Procedures
in Abdominal Wall Hernia Repair . . . . . . . . . . .493
66 In Support of Standard Procedure in
Hiatal Hernia Repair . . . . . . . . . . . . . . . . . . . . . . . .503
67 Strategy To Improve the Results?
In Support of Individualized Procedures
in Hiatal Hernia Repair . . . . . . . . . . . . . . . . . . . . .513
68 Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . .521
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .525