The Abdominal Wall Reconstruction program has been approved as a Center of Excellence by the School of Medicine at Creighton University. The significance of this center is the coordination of a comprehensive multidisciplinary group of physicians and staff members who have the experience and expertise to manage complex abdominal wall defects. The science of abdominal wall reconstruction and hernia repair has evolved significantly over the past 10 years. In a field formerly dominated by simple one or two layer suture techniques, now there are so many approaches that it can be difficult for surgeons to determine the best method not including primary care physicians and patients. Currently, laparoscopy is commonly recommended for different types of abdominal wall hernias, but has specific risks, which must be assessed in individual patients to ensure the operation is safe. On the other hand, conventional open surgery does not resemble what it did 20 years ago as simple suturing has been replaced by the use of prosthetic material in nearly all adult patients.
The mission of Creighton’s Center for Abdominal Wall Reconstruction is to provide consultative and treatment services for referring physicians and patients with these types of abdominal wall pathologies. Although always willing to assume care for the patients if the treating physicians so desires, we will be pleased to provide second opinion consultation services to surgeons who would like recommendations for the best approach for individual patients who could have the surgery in their local hospital closer to their friends and family.
In addition to its clinical activities, the Center will devote resources to scholarly activities including clinical trials and publication of results. Indeed, the center is actively negotiating with Baxter Health care, Inc. to perform a trial comparing the use of fibrin glue as a means to provide fixation for prosthesis to the usual tacks, staples and sutures, which are felt by some to contribute to the postherniorrhaphy pain syndromes.
Other clinical trials in development include a comparison of two different types of biological prosthesis. One is made from human skin and the other porcine. If the latter performs just as well, this would greatly simplify the procurement of the substance and decrease the cost. The last trial being developed deals with antiseptics for skin preparation to decrease infection.
The Director of the Center for Abdominal Wall Reconstruction is Dr. Robert Fitzgibbons, who is the Harry E. Stuckenhoff Professor of Surgery at Creighton. His clinical and research efforts over the past 18 years have focused on minimally invasive surgery and therapeutic laparoscopic surgery especially as it relates to the management of abdominal wall hernias. He has been instrumental in developing specific instruments and techniques for repairing hernias surgically. He has performed thousands of inguinal and ventral hernia repairs both conventional open and laparoscopic and is routinely called upon to perform demonstration operations in countries throughout the world.. This work has lead to two important randomized prospective multicenter trials dealing with the subject of inguinal hernia. He was the Principal Investigator of a grant, which was funded by the Agency for Health Care Related Quality, entitled “Management of Groin Hernia: A multi-centered Clinical Trial”, Principle (RO 1 HS/AG 9860-01A1) with a budget of more than $6,000,000. This landmark study confirmed that watchful waiting is a reasonable alternative to routine hernia repair for adult men with minimally symptomatic inguinal hernias. He was a co-investigator for VA Cooperative Study Trial #456: Tension-free Inguinal Hernia Repair: Comparison of Open and Laparoscopic Surgical Techniques, which was a randomized prospective trial comparing laparoscopic inguinal herniorrhaphy with its conventional counterpart. The budget was also nearly $6,000,000. He is a past president of the American Hernia Society and the Society of Laparoendoscopic Surgeons and a past board member of the Society of American Gastrointestinal Endoscopic Surgeons. He is a member of the committees on emerging technology for the American College of Surgeons and chairs its subcommittee on assessment. He has made more than 400 national and international presentations on subjects dealing primarily with hernia management and is the author of some 300 scholarly publications including peer and non-peer reviewed articles, books, book chapters, and videotapes mostly dealing with treatment of abdominal wall hernias.