Laparoscopic resection of inguinal recurrence of myxoid liposarcoma

In this key lecture, Dr. Adrian Park presents an overview of abdominal wall anatomy, function, defects and their management.

Access to the extraperitoneal space is a key step in the totally extraperitoneal approach for the management of inguinal hernia. Different techniques have been described. However, the safest technique remains a standardized approach to the muscular sheath of rectus abdominis muscles. In this film, we demonstrate the benefit of using a port equipped with a dilatation sheath. The entire procedure is also shown.

The description of the total extraperitoneal approach for hernia repair covers all aspects of the surgical procedure used for the management of inguinal hernia.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: creating the plane, dissecting balloon, 1st and 2nd trocars, dissection and 3rd trocar, clearing the internal ring, dangers, types of hernia, contralateral side, the mesh.
Consequently, this operating technique is well standardized for the management of this condition.

The objective of this film is to demonstrate stoma prolapse and parastomal incisional hernia repair according to the technique described by Sugarbaker in open surgery, reproduced here with a laparoscopic approach.
Mesh placement into the abdominal cavity presents a risk that seems minimized by the development of dual-sided composite meshes, with one collagen coating that will be in contact with the digestive tract, hence limiting the risk of adhesions.
The principle of the Sugarbaker technique is to create a colonic zigzag route and to fix it on the non-absorbable side of the mesh, thereby preventing colonic prolapse. The mesh is also used as an obstacle to the passage of small bowel loops into the parastomal defect.
Here, the difficulty lies in the combined presence of an incisional hernia and prolapse on a diverting transverse colostomy. The risk of vascular injury is all the more important. Here, authors highlight pitfalls as well as tips and tricks to overcome them.

In this video, Dr. Morales Conde outlines the main principles of strangulated umbilical hernia repair. After reduction of the contents of the hernia defect, adhesions are taken down and detached. The hernia defect is closed by means of a double loop suture and a piece of mesh which is sufficiently large to cover the hernia defect with a 5cm overlap of surrounding abdominal wall. The mesh is inserted and secured into position with two rows of tackers inserted concentrically.

The video "Laparoscopic TEP repair for right direct inguinal hernia" authored by B Dallemagne and J Marescaux is analysed by M Bailey, sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

In this key lecture, Dr. Nahabedian reviews the procedures of panniculectomy and abdominal wall reconstruction.

This video demonstrates the steps and technique in performing a Lichtenstein's tension-free open repair.The patient had a small indirect hernia sac, which was mobilized and reduced, and the mesh was secured over the posterior inguinal canal to control the hernia defect.

This is a video demonstrating the laparoscopic preperitoneal approach to repair a right inguinal hernia. The Veress needle is used directly at the beginning of the procedure to create the preperitoneal space. Interestingly, a psoas herniation is also discovered during the dissection. This video is suitable for general surgeons with an interesting laparoscopic hernia surgery.
The authors gain view of the pubic bone, following it to the Cooper’s ligament. Their goal is to create space with blunt dissection and gentle traction only. They proceed with caution to avoid the epigastric vessels. The hernia comes into view, but the authors remain close to the hernia sac to avoid the epigastric vessels until they discern the exact anatomy. This guides the operators to the hernia, and they then continue to develop additional lateral space.