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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