1. Wound Infection and Incisional Hernia Barry Salky, MD FACS Franz W. Sichel Professor of Surgery Division of Laparoscopic Surgery The Mount Sinai Hospital New York

3. Wound Infection and Incisional Hernia The incidence of wound infection and incisional hernia has decreased dramatically since the introduction of minimally invasive techniques.

4. Wound Infection and Incisional Hernia Risk factors: vertical incision acute surgery infection corticosteroids male gender smoking

5. Wound Infection and Incisional Hernia Does means of access into the abdomen affect the incidence of hernia formation after bowel resection? Dupree et al J Am Coll Surg, 2003

6. Wound Infection and Incisional Hernia 716 patients 2.4% laparoscopic 12.9% open P.00002 Dupree et al J Am Coll Surg, 2003

7. Wound Infection and Incisional Hernia “Incisional hernia after open versus laparoscopic sigmoid resection” 1995-2004 3.4% laparoscopic 14.7% open p.02 Andersen et als Surg Endosc 2008

8. Wound Infection and Incisional Hernia Can we do anything to decrease the incidence besides the precautions we already take?

9. Wound Infection and Incisional Hernia Learn how to be proficient with intracorporeal suturing and knot tying. That will decrease the conversion rate. Converting cases with enterotomy will increase the wound infection rate, and, thereby, the incidence of incisional hernia.

11. Wound Infection and Incisional Hernia Antibiotics one hour pre op for clean/contaminated and contaminated wounds. Redose appropriately Protect the extraction site with plastic barrier. Hemostasis of wound.

12. Wound Infection and Incisional Hernia Copius irrigation with saline. Remove all devitalized fat. Be gentle with the subcutaneous fat. Strongly consider secondary closure in contaminated wounds.

13. Wound Infection and Incisional Hernia In general, the smaller the incision, the less likely the incisional hernia rate. Welcome to laparoscopic surgery!

14. SAGES & CAGS host the 12 th World Congress of Endoscopic Surgery April 14 - 17, 2010 Gaylord National Resort and Convention Center Landover, MD (just outside Washington, DC) Registration & Program Information will be available Summer, 2009 Program Chairs: Barry Salky, MD (SAGES Chair) Daniel Herron, MD (SAGES Co-Chair) Christopher Schlachta, MD (CAGS Chair) Hosted by SAGES & CAGS Society of American Gastrointestinal and Endoscopic Surgeons and Canadian Association of General Surgeons