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5 th International Hernia Congress March28-31,2012 Marriott Marquis BG Medical/ Aspide Medical

5 th International Hernia Congress March28-31,2012 Marriott Marquis BG Medical/ Aspide Medical . Groin hernia repair: Changes in techniques and mentalities The Minimal Open Preperitoneal approach (minimal invasive and access!) Marc Soler , Cagnes sur Mer – France.

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5 th International Hernia Congress March28-31,2012 Marriott Marquis BG Medical/ Aspide Medical

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  1. 5th International Hernia Congress March28-31,2012 Marriott Marquis BG Medical/Aspide Medical Groin hernia repair: Changes in techniques and mentalities The Minimal Open Preperitoneal approach (minimal invasive and access!) Marc Soler, CagnessurMer – France

  2. the threesurgicalway for groin herniarepairwithprothesis Open surgery (anteriorapproach) Coeliscopicsurgery (posteriorapproach) The new way: posterior open or minimaly open approach

  3. The NyhusPreperitonealRepair, 1955-1960

  4. The Nyhus Preperitoneal Repair

  5. The Nyhus Preperitoneal Repair

  6. Henri R Fruchaud, 1956 Surgical Anatomie of groin herniaSurgical treatment of groin hernia The surgicaltreatment of inguinal or femoralhernias must not be the closure of the inguinal canal or the femoral ring, but the « deep reconstruction » of the abdominal wall in the whole groin region

  7. JEAN Rives 1965

  8. René Stoppa Giant prosthetic reinforcement of the viscéral sac 1967: First tension free and sutureless hernia repair

  9. GEORGES WANTZ • Unilateral GPRVS for the treatment of complex hernias • Ambulatory, local anesthesia

  10. Laparoscopic hernia surgery1992 Transperitonealapproach J. Leroy, G. Fromont Properitonealapproach G. Begin, JL Dulucq

  11. J.H. ALEXANDRE1981- INGUINAL APPROACH-CORD PARIETALISATION - M. P. O. OVERLAPPING

  12. Franz Ugahary1995

  13. Preperitoneal cleavage inferior epigastric vessels – medial hernia – cord structures

  14. Regular flat mesh Insertion of the mesh

  15. New prosthesis

  16. HERNIE INGUINO-SCROTALE

  17. HERNIE INGUINO-SCROTALE

  18. SPECIFIC MATERIAL

  19. SPECIFIC MATERIAL

  20. TIPP 2005 scrotal « approach » 6. Berrevoët et al. Hernia. 2009

  21. Marc Soler: CagnessurmerFrom March 2001 To September 2011 N =1575 (1358 patients) March 2001 TO february 2009: -regular flat mesh -Light weight mesh February 2009 TO September 2011 -New expandable mesh Since 09-2011 -New semi expandable mesh, less rigid

  22. Marc Soler: CagnessurmerNEW EXPANDABLE PROTHESIS2011-2012100 HERNIAS-91 PATIENTS FOLLOW UP: 6 months • RATE OF FOLLOW UP: 100% • 92 MEN, 8 WOMEN • PRIMARY: 92; SECONDARY: 8 • ANESTHESIA • GENERAL: withlaryngealmask: 42 • SPINAL: 3 • ILIO INGUINAL BLOCK: 55

  23. Marc Soler: CagnessurmerNEW EXPANDABLE PROTHESIS2011-2012100 HERNIAS-92 PATIENTS • HOSPITAL STAY: • DAY SURGERY 91 (91%) • ONE NIGHT OR MORE: 9 (9%) COMPLICATIONS Superficialhaematoma or seroma: 4 Infection: 0 Bladderretention: 0

  24. NEW EXPANDABLE PROTHESIS2011-2012100 HERNIAS-92 PATIENTS • Reccurence N=0 Discomfort • Discomfortwith normal activity: 12 • Difficultywith sport: 1 Moderate pain • with normal activity: 1 • Difficultywith sport: 1 • Necessity to stop hard work: 1 Necessity to have pain killer: 0

  25. NEW EXPANDABLE PROTHESIS100 HERNIAS-92 PATIENTS • VA SCALE • VAS DURING DAILY ACTIVITY • VAS=0: 85 VAS=4: 1 • VAS=1: 8 VAS=5: 2 • VAS=2: 1 VAS=8: 1 • VAS=3: 2 • For all the patient VAS 4 TO VAS 8, the pain isalwayslessthan the preoperative one • For these patients the resultsis: good: 6; Medium:1

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