Preface

Hernias of the abdominal wall include all cases in which the intestine protrudes from the site where it is contained due to a muscle-aponeurotic weakness or a pathological enlargement of natural orifices. Due to congenital causes and physiological ageing of the organism, all conditions of increased pressure inside the abdomen contribute to the onset of the disease.

Hernias of the abdominal wall are amongst the most treated diseases in all hospitals of the world.

Over the past 20 years, the introduction of prostheses in hernia surgery has almost completely replaced plastic abdominal wall interventions that use the patient's tissues to repair the hernial defect. Almost simultaneously, the introduction of laparoscopy has contributed to innovation in the treatment of this disease.

Today there are hundreds of types of non-absorbable, partially or fully absorbable, biological synthetic prostheses. New surgical techniques, conformed to the introduction of new types and forms of prosthetic material, can guide the surgeon in choosing the best approach for each individual patient.

Many interventions that treat hernial disease can now be performed in most parts of the world in outpatient surgery with local anaesthesia, guaranteeing a rapid recovery for the patients and an early return to normal daily activities. This has allowed for a reduction in public health spending and a greater availability of beds for the hospitalisation of more serious diseases.

Complications, however rare, seem to be minor in the centres dedicated to the treatment of hernial pathology.

The purpose of this book is to gather the experiences of distinguished authors from all over the world in order to assess the most common techniques, clarify ideas with the aim of providing guidance, and become acquainted with the most modern technological innovations.

**Dr. Angelo Guttadauro**

Researcher in General Surgery, Department of Medicine and Surgery, University of Milano-Biccocca, Head of Hernia Center Monza-Brianza, Clinical Unit of General Surgery, Italy

**1**

Section 1

Introduction

Section 1 Introduction

**3**

**Chapter 1**

*Angelo Guttadauro*

**1. Introduction**

**2. Tailored surgery**

**3. Problems**

Introductory Chapter: State of the

After the introduction of prostheses, wall surgery has undergone a progressive evolution aiming both at the development of new techniques and at the study of new and more comfortable prosthetic materials. Until recently the repair of a wall defect was carried out by direct suture of the muscle-aponeurotic structures and related to a high incidence of recurrence and postoperative pain. With the use of prostheses, surgeons are now able to adopt techniques and technologies more respectful of the original anatomy and physiology, avoiding tension between the muscle and tendon structures. This allows to reduce drastically the incidence of recurrence. Laparoscopy and robotic surgery, when used with the correct indications, are less traumatic and invasive and reduce postoperative pain. The higher costs allegated to these procedures are, in some cases, at least partially mitigated by the patient's better postoperative course and to a more rapid resumption of his work.

Today there are numerous open and laparoscopic surgical techniques available for the treatment of the various types of wall defects. The choice of the most appropriate technique for a specific patient remains fundamental. The concept of "tailored surgery" is new in this field and is based on the fact that each type of hernia and each patient are different from the other. Therefore surgical procedures should not be chosen according to the normal protocols but based on the needs and characteristics of that specific patient such as age, physical constitution, life habits, and work activity, but above all the size and type of the hernia should be considered. This would allow an effective treatment with the best comfort for the patient,

minimal hospitalization, and most rapid resumption of normal activities.

Among abdominal wall hernias, inguinal hernia repair is the most frequently performed surgical operation in all operating rooms around the world. Since the 1970s, one of the priorities in inguinal hernia surgery was that of minimizing postoperative chronic pain [1, 2]. All surgical techniques proposed during the few past years to improve patient's comfort reported a variable incidence of neuralgia [1–4] that, when persistent after 3–6 months from surgery, may compromise significantly the patient's quality of life. Pain may be related to the presence of the mesh that, depending on its size and location, may take contact with muscular structures or cause fibrotic entrapment of nerves when in subfascial position [5–7]. Studies

Art in Hernia Surgery

#### **Chapter 1**
