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Bard Level 1 Training > Ventral Hernias > Flashcards

Ventral Hernias Flashcards

0
Q

What are OVHR 5 techniques?

A 
Tissue to Tissue
Onlay
Retro-muscular
Pre-peritoneal
Intra-abdominal
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1
Q

Advantages of tissue-to-tissue repair

A

Simple

Inexpensive

No foreign body introduced

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2
Q

Disadvantages of tissue-to-tissue technique?

A

Tension on suture line

Can’t see other defects

Not suitable for large defects

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3
Q

Advantages of onlay technique?

A

Simple

Inexpensive

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4
Q

Disadvantages of onlay technique?

A

Numerous sutures to secure mesh

Inability to see other defects

Infection - mesh too close to skin
Lateral dissection - increased seroma - increase time required

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5
Q

Advantages of retro-muscular/pre-peritoneal repair?

A

Pascal’s law

Less risk of infection - mesh further away from skin

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6
Q

Disadvantages of retro-muscular/pre-peritoneal repair?

A

Lateral dissection - increased seroma - increased time

Potential issues with suture placement

Inability to see other defects

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7
Q

Best OVHR technique?

A

Intra-abdominal placement

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8
Q

Advantages of intra-abdominal technique?

A

Pascal’s law

Less risk of mesh becoming infected - furthest away from skin

Can locate additional defects***

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9
Q

Disadvantages of intra-abdominal repair?

A

Increased risk of bowel injury***

Must compromise the peritoneum

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10
Q

Advantages of LVHR?

A

Deep placement - Pascal’s Law

Quicker recovery

Minimally invasive

Quicker recovery

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11
Q

Disadvantages of Lap repair technique?

A

Technically challenging

Expensive

Adhesiolysis - increases time

Risk of intra-abdominal injury

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12
Q

Why is it important to have an adhesion barrier for mesh placed in the intra-abdominal cavity?

A

To protect the bowel from adhering to the mesh until the peritoneum grows back.

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13
Q

What is Davol’s permanent adhesion barrier

A

ePTFE

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14
Q

What is Davol’s absorbable adhesion barrier?

A

Sepra technology

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15
Q

What are the disadvantages of using 100% ePTFE products?

A

?

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16
Q

What benefit does the original Composix offer?

A

.

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17
Q

Composix EX Advantages

A

Rapid tissue in-growth - due to monofilament polypropylene

Prevents bowel adhesions with ePTFE barrier

Overlap prevents adhesions to the edge of polypropylene with ePTFE barrier

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18
Q

Composix LP advantages

A
  • Rapid tissue in-growth with uncoated monofilament polypropylene
  • LOW PROFILE enables all sizes to be inserted into a trocar / large pore mesh
  • prevents bowel adhesions with ePTFE barrier
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19
Q

Why was Composix LP developed?

A

Surgeons wanted mesh to fit through trocar easier.

Surgeons are interested in lighter weight, large pore mesh.

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20
Q

What is the benefit of Composix LP over Composix EX?

A

Comes with an introducer tool to assist with rolling and introducing mesh through trocar

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21
Q

What are the key differences between Composix EX and LP?

A

LP has 15% larger pores and 50% lighter weight.

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22
Q

Describe technique for Composix EX and LP.

11 steps

A
  1. Place ports
  2. ID defect
  3. Reduce hernia and take down adhesions
  4. Measure defect and determine proper mesh size
  5. Pre place center stitch
  6. Roll mesh 7. Deploy through trocar
  7. Position mesh 9. Fixate in opposing corners
  8. Fixate perimeter 11. Fixate double crown
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23
Q

What is the benefit of PGA fibers?

A

Provides added strength to repair during incorporation into abdominal wall.

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24
Describe features and benefits of hydrogel barrier.
Minimizes tissue attachment to prosthesis Allows complete peritoneal growth over mesh
25
Advantages of Ventralight ST
Rapid tissue in-growth with monofilament polypropylene Provides added strength to repair with PGA fibers Prevents bowel adhesions with Sepra Technology Proven Sepra brand
26
Features and benefits of SepraMesh IP
1 layer of uncoated monofilament polypropylene for rapid tissue in-growth PGA fibers bind polypropylene to Sepra barrier to provide added strength to repair Proven Sepra technology prevents bowel adhesions and absorbs in 30 days
27
Materials used in SepraMesh IP and Ventralight ST
1 layer of uncoated monofilament polypropylene PGA fibers Sepra technology with hydrogel barrier
28
Describe lap technique for using Ventralight ST and SepraMesh IP 12 steps
1. Place ports 2. ID defect 3. Reduce hernia and take down adhesions 4. Measure defect and determine proper mesh size 5. Hydrate mesh 6. Roll mesh 7. Insert mesh through trocar 8. Position mesh below defect 9. Fixate in opposing corners 10. Fixate permimeter 11. Fixate double crown 12. Deflate and close
29
What is the difference between SepraMesh IP and Ventralight ST?
50% lighter weight 15% larger pore size Lighter color
30
Describe Echo PS positioning system
Low profile, thermoplastic polyurethane (TPU) coated nylon balloon pre-attached to Ventralight ST or Composix LP
31
Which 2 products can come attached to Echo PS?
Ventralight ST and Composix LP
32
What purpose Echo PS serve in LVHR
Serves as 3rd arm of doctors. Reduces the frustration involved in placing the mesh.
33
What is the surgeon targeting strategy for Echo PS?
Go to your current customers first who are satisfied with Ventralight mesh Once you have practiced and perfected your pitch, go after competition.
34
Describe the technique for using Echo PS.
1. Verify all components 2. Hydrate ST 3. Roll with introducer tool 4. Deploy through trocar 5. Pull inflation tube up through center of defect 6. Assemble inflation device 7. Inflate balloon 8. Position mesh over defect 9. Initial fixation 10. Deflate by cutting inflation tube at skin level 11. Remove balloon from mesh 12. Pull balloon up to trocar and remove both together 13. Finish fixation
35
Advantages of Echo PS
Easy insertion Effortless placement Positioning and assisted fixation
36
Describe design of Ventrio and Ventrio ST
2 layers of uncoated monofilament polypropylene forming positioning pocket Absorbable PDO ring - causes patch to spring open and lie flat ePTFE barrier
37
Advantages/ benefits of Ventrio/Ventrio ST
Provides the benefits of a lap repair through ease of an open approach Time savings Proven shorter patient recovery Proven low complication and recurrence rate
38
Describe Ventrio ST technique
1. Incision 2. Id the defect 3. Reduce hernia 4. Take down adhesions 5. Clear area 5-7 cm and determine patch size 6. Hydrate and roll (only for ST) 7. Insert patch 8. Check patch popped open 8. Pretension fascia 9. Fixate quadrants 10. Fixate mesh perimeter 11. Suture bites in pocket 12. Close fascia. Close wound
39
What are the advantages of the Ventrio technique?
Provides the benefits of lap repair through ease of open approach
40
Describe the design of Ventralex and Ventralex ST
2 layers of uncoated monofilament polypropylene forming positioning pocket and straps (standard pore) Permanent PET ring - causes to spring open ePFTE barrier OR ST adhesion barrier
41
List features and advantages of Ventralex
Encourages rapid tissue in-growth with uncoated monofilament polypropylene Facilitates proper placement, positioning and fixation with positioning pocket and straps PDO ring allows patch to open and lay flat to maintain it's shape ePTFE minimizes tissue attach,net to mesh's posterior Proven #1 prosthetic for umbilical hernia repair on the market
42
Features and advantages of Ventralex ST.
Encourages rapid tissue in-growth with uncoated monofilament polypropylene Facilitates proper placement, positioning and fixation with positioning pocket and straps PDO ring allows patch to open and lay flat to maintain it's shape Proven Sepra Technology adhesion barrier Proven #1 prosthetic for umbilical hernia repair on the market
43
What are the indications for using Ventralex
Open umbilical hernia repairs
44
Describe technique for using Ventralex
1. Incision 2. Id defect 3. Excise and reduce 4. Clear area 2x size of the defect 5. Fold and insert 6. Patch pops open, pull up on straps 7. Ensure patch is laying flat 8. Pull straps apart 9. Suture in quadrants 10. Suture straps then cuts straps 11. Close fascia
45
Describe Sepra Technology
Prevents bowel adhesions Absorbs in 30 days or less Hydrogel swells to protect adhesions to edge of mesh Proven Sepra brand
46
Describe Ethicon Proceed surgical Mesh
(Thick cream mesh with blue stripes) Polypropylene mesh PDO encapsulates mesh and provides bonding agent to adhesion barrier ORC - absorbable adhesion barrier
47
Weaknesses of Ethicon Proceed List 3
- PDO Bonds mesh to ORC (adhesion barrier) and also Inhibits tissue growth ***ORC - states should not be used in presence of blood No design to help with open repairs
48
Davol product to position against Ethicon Proceed
Ventrio ST
49
Describe Ethicon Proceed Ventral Patch PVP
(Thick cream round mesh with blue stitching) Multi-filament polyester Vicryl mesh encapsulated in PDO Inner rings PDO Straps and posterior Proceed
50
Weaknesses/Disadvantages of Ethicon PVP
Limited clinic data Contains proceed Only 2 sizes - no large Lacks design features like Ventralex
51
Davol product to position against Ethicon PVP
Ventralex ST
52
Describe Ethicon Physiomesh
(Lightweight, large pore with stripe down middle) Layers Monocryl, PDS, Monocryl Polypropylene mesh
53
Describe Ethicon Physiomesh weaknesses
No data Monocryl on both sides No adhesion barrier overlap Lacks design features to open repair May be too lightweight
54
Davol product to position against Ethicon Physiomesh
Ventralight ST
55
Covidien Parietex Composite mesh | Weaknesses/disadvantages
...
56
Davol products to position against Covidien Parietex Composite mesh
Ventralex ST with Echo PS
57
Describe Covidien Parietex Composite
...
58
Describe Covidien Parietex OS mesh
...
59
Describe Covidien Parietex OS mesh | Weaknesses
...
60
Covidien Parietex Composite Ventral Patch | Describe
...
61
Covidien Parietex Composite Ventral Patch | Weaknesses
...
62
Covidien Accusmesh positioning system | Describe
...
63
Covidien Accumesh PS | Weaknesses
...
64
Davol product to sell against Covidien Parietex Composite Ventral Patch
...
65
Davol product to sell against Covidien Parietex OS
....
66
Covidien Symbotex | Describe
(White large pore, blue tear drop) | Monofilament polyester
67
Covidien Symbotex | Weaknesses
...
68
Davol product to sell against Covidien Symbotex
Ventralight ST | SepraMesh IP
69
Iannitti white paper - strength of tissue attachment to mesh after ventral hernia repair with synthetic composite mesh in a porcine model
Results - 74% of tissue in-growth occurs within first 2 weeks after surgery Uses - casts doubt on competitive products where interstices are covered - how much in-growth is achieved
70
Iannitti - techniques and outcomes of abdominal incisional hernia repair using synthetic mesh - report of 455 cases
R - low recurrence rate, low early infection rate Uses - defend ePTFE - clinical data showing good outcomes Ventrio/ ST open technique Relating product design to technique to good outcomes
71
Burger white paper - evaluation of new prosthetic meshes for ventral hernia repair
R- SepraMesh and panetex are best options U - positioning Sepra against competition
72
Voeller white paper - Ventralex Mesh in umbilical/epigastric hernia repairs
U - clinical proof of efficacy of Ventralex | - positioning and defending Ventralex
73
Gilliam white paper
....
74
Archer Poster - single arm, single center, retrospective study with prospective follow-up of LVHR utilizing SepraMesh
U - proves efficacy of SepraMesh

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