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הכנס הבינלאומי הראשון של כל איגודי ההרניה הבינלאומיים, מילאנו אפריל 2015

פרופ' דודאי מוזמן להרצות ומציג עבודות מחקר ופיתוח שלו בכנסים פרסונליים בינלאומיים.

פרופ' דודאי העביר בכנס שתי הרצאות:

פרופ' דודאי הוזמן להיות חבר בפנל של בקע ספורטאים ולהרצות.

According to the SH guiltiness and the recent update, surgery is superior to conservative treatment for SH –Level 1A of evidence- and Endoscopic Total Extra Peritoneal (TEP) retro- pubic and posterior wall mesh placement is the recommended treatment for SH with excellent results – Level 1A of evidence-. Specific surgical maneuvers adapted for the SH have to be add to the mesh placement.  On the other hand conservative treatment of Active Isometric Weight Bering Exercises (AIWBE) is recommended for AP when quit all recovered in 8-12 weeks –Level 1A of evidence-.

In our experience we found that part of the athletes presenting with findings of both types of SGI with different level of severity. SH is persistently bilateral but PBSI expressed in different level of severity; grade 1-5. We were impressed that the SH was the first injury and because the athlete continue with extreme sport activities on top of the SH injury, others PBSI be caused. We worked in cooperation with physiotherapist and sport physiologist to build up a program that is a combination of Endoscopic TEP posterior wall repair and reinforcement by mesh combined with Muscles Sport Rehabilitation (MSR) (AIWBE for peripheral muscles and Core Muscles Strength and balance Exercise). We had found that the more effective and shorter recovery combination is starting with the surgery, repairing and giving strength to the groin that act as an anchor for the active healing process of the muscles and tendons.

Athletes suffered from SGI have to be diagnosed correctly of the subtype injury, SH or AP, for selecting the surgical or the conservative way of treatment. Some of the athletes having both SH and AP, in these sportsman combined treatments of Endoscopy with MSR has to be tailored according to the severity of the PBSI injuries. If the right treatment is selected the results are excellent and in shorter time

Submitted for topic:

PIPS; Sportsman hernia

Moshe Dudai MD FACS,

Hernia Excellence, Ramat Aviv Medical Center, Tel Aviv, Israel

info@hernia-excellence.com, dudai@netvision.net.il ,

Cell 052-406-2727; Tel 077-706-0496; Fax 077-706-2024

3 Louis Pasture ST. Tel Aviv 68036 Israel

NEW APPROACHES TO SPORTSMAN HERNIA; LOGICAL INTEGRATION BETWEEN SURGERY AND MUSCLES SPORT REHABILITATION

Moshe Dudai MD FACS, Hernia Excellence, Ramat Aviv Medical Center, Tel Aviv

Sport Groin injuries are very common among professional Athletes but lastly become common also in sport active people. In part is treated by conservative treatment and in part by Endoscopic surgery. Making the diagnosis for selecting the right treatment it is a challenge but lastly become more feasible after publishing the new guidelines for diagnosis and treatment of Sportsman Hernia. In some of the cases there is more complexes injury that will need combined Endoscopic surgery with conservative treatments.

There are well defined two kinds of Sport Groin Injury (SGI); the Sportsman Hernia (SH) – Posterior Wall Deficiency (PWD) and the Athletes Pubalgia (AP) – Pubic Bone Stress Injury (PBSI). The different criteria for diagnosis and treatment of this two SGI were clearly described in the Guiltiness for Sportsman Hernia as part of the International Endo Hernia guidelines published in the Journal Surgical Endoscopy 2011 and the recent update. In general the symptoms of SH are more lateral in the groin, sharp pain radiated to the inner tight aspect with neurologic characteristic while the AP is more central , dull continues pain with inflammatory characteristic. The background pathology for SH is sport trauma causing small and irreversible tears and weakening of the posterior inguinal wall facial sheets and the adjusted tendons while in the AP there is a stress injury with edema and inflammatory process in the Symphysis Pubis, Pubic bone and ligaments including the tendons of the attached muscles; Rectus, Pyramidal and Adductors. Beside of different findings by anamnesis and physical examination, Dynamic US can demonstrate the SH pathology and MRI the AP pathology.


לינק לצפיה במצגת של ההרצאה:

https://1drv.ms/p/s!Amya0-mngLlUgv5I2pK7QPLqvsc7cQ 

פרופ' דודאי גם הרצה על הניתוחים האנדוסקופים לבקעים מפשעתיים מסובכים –

A Risky Hernia is that one that you know that has a high chance for recurrence. The two main groups are: a) Edematous tissue surface that will cause the mesh to slip and not to incorporate. Typical two examples are: Incarcerated Hernia and protein malnutrition (not so uncommon situation!). b) Tissue healing deficiency that will affect the collagen formation process. Typical pathologies are: Smoking, Obesity and systemic Steroid treatment. For the "Edematous tissue" group you should not select the posterior approach that needs a surface for mesh incorporation. For the "Healing deficiency" group you should select the posterior TEP approach with wide mesh and extra fixation and not to be depended on the anterior tissue healing. Less risk for infection as well.

Complicated Groin Hernia is a challenge for the surgeon and the patient and should be repair by Hernia expert. Expert experience is needed for the surgical skill but also for selecting the right surgery that has to be tailored to the patient condition. For Recurrent and Big Hernia you can have similar results as for regular hernia, for Risky Hernia you can improve the results.

Submitted for topic:

Inguinal Hernia; Recurrence…

Moshe Dudai MD FACS,

Hernia Excellence, Ramat Aviv Medical Center, Tel Aviv, Israel

info@hernia-excellence.com, dudai@netvision.net.il ,  

Cell 052-406-2727; Tel 077-706-0496; Fax 077-706-2024

3 Louis Pasture ST. Tel Aviv 68036 Israel


לינק לצפיה במצגת של ההרצאה:

https://1drv.ms/p/s!Amya0-mngLlUgt14_a4cvWFHleH79g

COMPLICATED GROIN HERNIA: RECURRENT, BIG, AND RISKY.

Moshe Dudai MD FACS, Hernia Excellence, Ramat Aviv Medical Center, Tel Aviv, Israel

The debate between Lap/Endo versus Open Groin Hernia repair for the average patient is not    completed yet, but Complicated Hernia is much more undefined. We like to light up the variety and complexity of the treatments and to describe our outcome experience of the Complicated Hernia.

Recurrent Hernia it is a real challenge for the surgeon, the patient is suffering from a failed repair and he should not confront more a risk of recurrence! Recurrent Hernia should be repair by Hernia expert and not by a surgeon that do by the others hernia repair. Failed tissue repair widely accepted that should be repaired with mesh. Known statement is that failed anterior repair has to be repair by posterior repair and failed posterior repair (Lap/Endo) by anterior one. This is because you like to repair with virgin tissue and to escape the failed mesh. This statement ignores the fact that posterior failed mesh still can trap a bowel after anterior repair. Recurrence after Lap/Endo occurs because of inaccurate mesh placement or incomplete dissection. In our experience Lap TAPP approach gives excellent view of the place and reason of the recurrence and ability to complete the repair of the pathology without the need to repeat the entire repair!

Big Hernia has higher risk for recurrence, mostly because the defect in the posterior inguinal wall is big. Big defect will need a bigger size of mesh, the posterior approach will enable placement of larger mesh size. For very big defect there is a limit of the mesh size one can place and to the amount of fixation. In spite of this understanding the recurrence of Big Hernia is higher than of regular hernia. In 1994 we published in Nyhus Hernia textbook our technique of two layers of repair for big hernia; a dynamic plug "Dudai butterfly" in the defect as first layer and a wide mesh on top as a second layer. Since then to date we are using this technique with very good results similar to the regular hernias.

Risky Hernia is the one you know has a high chance for recurrence. The two main groups are: a) Edematous tissue surface that will cause the mesh to slip and not to incorporate. Typical two examples are: Incarcerated Hernia and protein malnutrition. b) Tissue healing deficiency that will affect the collagen formation process. Typical pathologies are: Smoking, Obesity and systemic Steroid treatment. For the "Edematous tissue" group you should not select the posterior approach that needs a surface for mesh incorporation. For the "Healing deficiency" group you should select the posterior TEP approach with wide mesh and extra fixation and not to be depended on the anterior tissue healing.

Complicated Groin Hernia is a challenge to the surgeon and to the patient and should be repair by Hernia expert. Expert experience is needed for the surgical skill gaining but also for selecting the right surgery that has to be tailored to the patient condition.

Moshe Dudai MD FACS,

Hernia Excellence, Ramat Aviv Medical Center, Tel Aviv, Israel

info@hernia-excellence.com, dudai@netvision.net.il ,  

Cell 052-406-2727; Tel 077-706-0496; Fax 077-706-2024

3 Louis Pasture ST. Tel Aviv 68036 Israel


לינק לצפיה במצגת של ההרצאה:

https://1drv.ms/p/s!Amya0-mngLlUgt14_a4cvWFHleH79g

COMPLICATED GROIN HERNIA: RECURRENT, BIG, AND RISKY

Moshe Dudai MD FACS, Hernia Excellence, Ramat Aviv Medical Center, Tel Aviv, Israel

Affiliations

1 Hernia Excellence, Ramat Aviv Medical Center, Tel Aviv, Israel

Body

The debate between selecting Lap/Endo versus Open Groin Hernia repair for the average patient is not completed yet, but for Complicated Hernia is much more undefined. We like to light up the complexity of the treatments and to describe our recommendation for the Complicated Hernia.

Recurrent Hernia it is a challenge for the surgeon, but the patient should not confront another risk of recurrence! Recurrent Hernia should be repair by Hernia expert and not by a surgeon that do by the others hernia repair. Failed tissue repairs should be repaired with mesh. Known statement is that failed anterior repair has to be repair by posterior repair and Vic avers. The rational is to repair in a virgin tissue and to escape the failed mesh. This statement ignores the fact that posterior failed mesh still can trap a bowel if anterior re-repair was done. Recurrence of Lap/Endo occurs because of inaccurate mesh placement or incomplete dissection. In our experience Lap TAPP approach gives excellent view of the place and reason of the recurrence and ability to complete the repair of the pathology without the need to repeat the entire repair!

Big Hernia has big defect and higher risk for recurrence. Big defect will need a bigger size of mesh; the posterior approach will enable placement of larger mesh size. For very big defect there is a limit of the mesh size and the amount of fixation. In 1994 we published in Nyhus Hernia textbook our technique of two layers of repair for big hernia; a dynamic plug "Dudai butterfly" in the defect as first layer and a wide mesh on top as a second layer. We are using this technique with very good results similar to the regular hernias.

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