Management of a primary ventral incisional hernia: a survey of the International Hernia Collaboration.

A social media group, the International Hernia Collaboration (IHC), facilitates professional development among surgeons interested in hernia disease. The purpose of this study was to assess practice pattern differences among IHC surgeon members regarding a ventral incisional hernia (VIH) scenario. A single multiple-choice question, posted for 1 month on the IHC, assessed which operation was preferred for a healthy patient with a symptomatic, reducible primary VIH (5 × 6 cm).

Technique of laparoscopic ventral hernia repair can be modified to successfully repair large defects in patients with loss of domain.

Background: Laparoscopic ventral hernia repair (LVHR) can be challenging in patients with large abdominal wall defects and loss of domain (LOD). When hernia contents are reduced, the pneumoperitoneum preferentially fills the sac, leaving no space for mesh manipulation. This study presents a modification for LVHR in LOD patients, as well as outcomes for a series of patients.

Prospective, randomized, double-blind trial of curriculum-based training for intracorporeal suturing and knot tying.

Background: Advanced surgical skills such as laparoscopic suturing are difficult to learn in an operating room environment. The use of simulation within a defined skills-training curriculum is attractive for instructor, trainee, and patient. This study examined the impact of a curriculum-based approach to laparoscopic suturing and knot tying.

Construct validity of an objective assessment method for laparoscopic intracorporeal suturing and knot tying.

Background: The ideal objective assessment method for laparoscopic technical skills is difficult to achieve in the operating room. Recent "VR2OR" studies have used a blinded, 2-reviewer error-based video tape analysis for intraoperative performance assessment. This study examines the validity of this methodology applied to laparoscopic intracorporeal suturing and knot tying.

Abnormal primary tissue collagen composition in the skin of recurrent incisional hernia patients.

Recurrence of incisional hernia may be as high as 50 per cent. Abnormal collagen I/III ratios have been observed within scar tissue of patients with recurrent incisional hernias. We sought to determine whether collagen composition in primary, nonscarred tissue was similarly affected in these patients.

A comparison between fluoroscopically guided radiofrequency energy delivery and conventional technique in an animal model of fundoplication failure.

Background: The use of radiofrequency energy (RFe) treatment at the gastroesophageal junction (GEJ) has been considered an alternative to surgery after fundoplication disruption. It is unknown whether the recommended delivery technique for primary gastroesophageal reflux disease applies to an anatomically altered GEJ following fundoplication. The aim of this study was to determine whether modifications to the standard technique using fluoroscopic guidance more accurately localizes ablation zones compared with standard technique alone.

Diagnosis and contemporary management of anastomotic leaks after gastric bypass for obesity.

Background: Anastomotic leaks are a dreaded complication of bariatric surgery. The objective of this study was to describe the clinical presentation and outcomes of treatment in patients who develop anastomotic leaks after Roux-en-Y gastric bypass for obesity.

Study Design: Prospectively collected data on 3,018 consecutive patients who underwent Roux-en-Y gastric bypass in 4 tertiary referral centers were reviewed.

Evaluation of a tensiometer to provide objective feedback in knot-tying performance.

Training and assessment methods for knot tying by medical students or residents have traditionally been subjective. Objective methods for evaluating creation of a tied knot should include assessing the strength and quality of the knotted suture. The purpose of this study was to evaluate the use of a tensiometer as a feedback device for improving knot-tying performance.

Pheochromocytomas and paragangliomas in von Hippel-Lindau disease: a role for laparoscopic and cortical-sparing surgery.

Hypothesis: Von Hippel-Lindau disease (VHL) is an autosomal-dominant disorder characterized by benign and malignant tumors involving the central nervous system, kidneys, pancreas, adrenal glands, and paraganglia. Appropriate management of pheochromocytomas and paragangliomas in VHL is evolving as we better understand the genetics and natural course of the disease and master advanced surgical techniques for adrenalectomy.

Design: Retrospective chart review.

Subjective and objective comparison of critical care pathways for open donor nephrectomy.

Purpose: In the era of minimally invasive techniques and cost containment, care pathways after donor nephrectomy are important. While open donor nephrectomy remains the established procedure, questions regarding the surgical approach, postoperative care and patient morbidity/dissatisfaction have surfaced. We compared results of standard and fast-track care pathways after donor nephrectomy.