Surgical Advances in the Treatment of Abdominal Wall Hernias
In the last two decades, the surgery of the abdominal wall has experienced an important development from being considered a matter of little interest for general surgeon, to having a greater presence at scientific meetings and to being increasingly prominent in the specialist training in surgery. In 1990 the plastic surgeon Oscar Ramírez published a method to repair defects in the abdominal wall that called “Component Separation Technique” thereafter general surgeons fixed his attention on the techniques of autoplastic repair of the abdominal wall that had already developed throughout the twentieth century. This interest grows with the emergence of new prosthesis and the use of laparoscopic surgery to repair eventrations since Le Blanc and Booth published in 1993. The development of techniques and materials encourages surgeons to repair large defects in the abdominal wall, using preoperative procedures to avoid complications arising from the return of viscera to a reduced abdominal cavity; it recovers the use of preoperative progressive pneumoperitoneum and the muscular expanders; it applies the use of botulinum toxin in transverse abdominal muscles. Surgery of the large eventrations, however, is not free of complications such as skin necrosis which is treated by negative pressure therapy; it is necessary to control the intra-abdominal pressure (IAP) and the development of techniques for the treatment of the open abdomen with subsequent progressive or delayed closure of the abdominal cavity. The complexity of surgical techniques and the knowledge of pre- and postoperative procedures to prevent and treat complications, in addition to the wide variety of prosthetic materials used, they justify the creation of abdominal wall surgery units in large hospitals, thus contributing to become an exciting topic for new generations.
KeywordsAbdominal wall reconstruction Separation of components Preoperative progressive pneumoperitoneum Botulinum toxin Intra-abdominal pressure Vacuum-assisted therapy Biomaterial Biofilm