Advertisement

Ventral Hernia Surgery in Europe: Trends and Actual Situation

  • S. G. Parker
  • A. C. J. Windsor
Chapter

Abstract

Ventral hernia surgery has evolved into the highly complex surgical specialty with challenging comorbid patients. In the first half of this chapter, the trends and developments of ventral hernia surgery in Europe over the last 100 years are outlined, and the important discoveries that have changed our surgical practice are highlighted. The second half describes the current practice of ventral hernia surgery, the use of innovative surgical techniques and multidisciplinary teams, the emergence of national specialist hernia centres, the use of negative pressure dressings and the development of national ventral hernia databases.

References

  1. 1.
    Earle DB, Mark LA. Prosthetic material in inguinal hernia repair: how do I choose ? Surg Clin North Am. 2008;88:179–201.CrossRefPubMedGoogle Scholar
  2. 2.
    Nuttall HC. Rectus transplantation in the treatment of ventral herniae. Br Med J. 1926;1(3395):138–9.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Shelton J, Poulose BK, Phillips S, Moore D, Nealon W, Penson D, et al. Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia. 2012;16:179–83.CrossRefPubMedGoogle Scholar
  4. 4.
    Flum DR, Horvath K, Koepsell T. Have outcomes of incisional hernia repair improved with time? A population-based analysis. Ann Surg. 2003;237(1):129–35.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Daddas N, Adams K, Pearson K, Royle GT. Frequency of abdominal wall hernias: is classical teaching out of date? J R Soc Med. 2011;2(1):1–6.Google Scholar
  6. 6.
    Moreau P-E, Helmy N, Vons C. Laparoscopic treatment of incisional hernia. State of the art in 2012. J Visc Surg [Internet]. 2012;149:e40–8. http://www.ncbi.nlm.nih.gov/pubmed/23137646
  7. 7.
    Fink C, Baumann P, Wente MN, Knebel P, Bruckner T, Ulrich A, et al. Incisional hernia rate 3 years after midline laparotomy. Br J Surg. 2014;101:51–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Kokotovic D, Bisgaard T, Helgstrand F. Long-term recurrence and complications associated with elective incisional hernia repair. JAMA. 2016;316(15):1575–82.CrossRefPubMedGoogle Scholar
  9. 9.
    Rios A, Rodriguez JM, Munitz V, Alcaraz P, Perez D, Parrilla P. Factors that affect recurrence after incisional herniorrhaphy with prosthetic material. Eur J Surg. 2001;167:855–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Bosanquet DC, Ansell J, Abdelrahman T, Cornish J, Harries R, Stimpson A, et al. Systematic review and meta-regression of factors affecting midline Incisional hernia rates: analysis of 14 618 Patients. PLoS One. 2015;10(9):1–18.  https://doi.org/10.1371/journal.pone.0138745CrossRefGoogle Scholar
  11. 11.
    Helgstrand F, Rosenberg J, Kehlet H, Strandfelt P, Bisgaard T. Reoperation versus clinical recurrence rate after ventral hernia repair. Ann Surg [Internet]. 2012;256(6):955–8. http://www.ncbi.nlm.nih.gov/pubmed/22580941
  12. 12.
    Comajuncosas J, Hermoso J, Gris P, Jimeno J, Orbeal R, Vallverdú H, et al. Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. Am J Surg. 2014;207(1):1–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Jenkins TPN. The burst abdominal strength: a mechanical approach. Br J Surg. 1976;63:873–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Jenkins T. Incisional hernia repair: a mechanical approach. Br J Surg. 1980;67:335–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Mayer AD, Ausobsky JR, Evans M, Pollock AV. Compression suture of the abdominal wall: a controlled trial in 302 major laparotomies. Br J Surg. 1981;68(9):632–4.CrossRefPubMedGoogle Scholar
  16. 16.
    Israelsson LA, Jonsson T, Knutsson A. Suture technique and wound healing in midline laparotomy incisions. Eur J Surg. 1996;162(8):605–9.PubMedGoogle Scholar
  17. 17.
    Diener MK, Voss S, Jensen K, Büchler MW, Seiler CM. Elective midline laparotomy closure: the INLINE systematic review and meta-analysis. Ann Surg [Internet]. 2010;251(5):843–56. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00000658-201005000-00011CrossRefGoogle Scholar
  18. 18.
    Deerenberg EB, Harlaar JJ, Steyerberg EW, Lont HE, Van Doorn HC, Heisterkamp J, et al. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet. 2015;386:1254–60.CrossRefPubMedGoogle Scholar
  19. 19.
    Brown S, Goodfellow P. Transverse versus midline incisions for abdominal surgery. Cochrane Database Syst Rev [Internet]. 2005;(4). http://www.ncbi.nlm.nih.gov/pubmed/16235395
  20. 20.
    Timmermans L, De Goede B, Eker HH, Van Kempen BJH, Jeekel J, Lange JF. Meta-analysis of primary mesh augmentation as prophylactic measure to prevent incisional hernia. Dig Surg. 2013;30:401–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Muysoms FE, Jairam A, López-Cano M, Śmietański M, Woeste G, Kyle-Leinhase I, et al. Prevention of incisional hernias with biological mesh: a systematic review of the literature. Front Surg [Internet]. 2016;3(September):53. http://journal.frontiersin.org/Article/10.3389/fsurg.2016.00053/abstract%0Ahttp://www.ncbi.nlm.nih.gov/pubmed/27725931%0A; http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5035749
  22. 22.
    Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D, et al. European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia. 2015;19(1):1–24.CrossRefPubMedGoogle Scholar
  23. 23.
    Kurmann A, Visth E, Candinas D, Beldi G. Long-term follow-up of open and laparoscopic repair of large incisional hernias. World J Surg. 2011;35(2):297–301.CrossRefPubMedGoogle Scholar
  24. 24.
    Sorensen LT, Hemmingsen UB, Kirkeby LT. Smoking is a risk factor for incisional hernia. Arch Surg. 2015;140:119–23.CrossRefGoogle Scholar
  25. 25.
    Hornby ST, McDermott FD, Coleman M, Ahmed Z, Bunni J, Bunting D, et al. Female gender and diabetes mellitus increase the risk of recurrence after laparoscopic incisional hernia repair. Ann R Coll Surg Engl. 2015;97(2):115–9.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Helgstrand F, Rosenberg J, Kehlet H, Jorgensen LN, Bisgaard T. Nationwide prospective study of outcomes after elective incisional hernia repair. J Am Coll Surg. 2013;216(2):217–28.CrossRefPubMedGoogle Scholar
  27. 27.
    Finan KR, Vick CC, Kiefe CI, Neumayer L, Hawn MT. Predictors of wound infection in ventral hernia repair. Am J Surg. 2005;190(5):676–81.CrossRefPubMedGoogle Scholar
  28. 28.
    Satterwhite TS, Miri S, Chung C, Lorenz HP, Lee GK. Outcomes of complex abdominal herniorrhaphy. Ann Plast Surg. 2012;68(4):382–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Cobb WS, Warren JA, Ewing JA, Burnikel A, Merchant M, Carbonell AM. Open retromuscular mesh repair of complex incisional hernia: predictors of wound events and recurrence. J Am Coll Surg [Internet]. 2015;220(4):606–13.  https://doi.org/10.1016/j.jamcollsurg.2014.12.055CrossRefGoogle Scholar
  30. 30.
    Timmermans L, De Goede B, Van Dijk SM, Kleinrensink GJ, Jeekel J, Lange JF. Meta-analysis of sublay versus onlay mesh repair in incisional hernia surgery. Am J Surg [Internet]. 2014;207:980–8.  https://doi.org/10.1016/j.amjsurg.2013.08.030CrossRefGoogle Scholar
  31. 31.
    Bencini L, Sanchez LJ, Bernini M, Miranda E, Farsi M, Boffi B, et al. Predictors of recurrence after laparoscopic ventral hernia repair. Surg Laparosc Endosc Percutan Tech [Internet]. 2009;19(2):128–32 LID– https://doi.org/10.1097/SLE. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=19390279
  32. 32.
    Hauters P, Desmet J, Gherardi D, Dewaele S, Poilvache H, Malvaux P. Assessment of predictive factors for recurrence in laparoscopic ventral hernia repair using a bridging technique. Surg Endosc [Internet]. 2017.; http://www.ncbi.nlm.nih.gov/pubmed/28078462%0A; http://link.springer.com/10.1007/s00464-016-5401-0
  33. 33.
    Wiener J. Silver wire and linen thread for the cure of hernia. Ann Surg. 1910;52(5):678–99.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Usher FC, Ochsner J, Tuttle LLJ. Use of marlex mesh in the repair of incisional hernias. Am Surg. 1958;24(12):969–74.PubMedGoogle Scholar
  35. 35.
    Stoppa RE. The treatment of complicated groin and incisional hernias. World J Surg. 1989;13:545–54.CrossRefPubMedGoogle Scholar
  36. 36.
    Rives J. Major incisional hernia. In: Chevrel JP, editor. Surgery of the abdominal wall. Paris: Springer; 1987. p. 116–44.Google Scholar
  37. 37.
    Luijendijk R, Hop WCJ, van den Tol P, de Lange DCD, Braaksma MMJ, Ijzermans JNM, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343(6):392–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Burger J, Luijendijk R, Hop WCJ, Halm JA, Verdaasdonk EGG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004;240(4):578–85.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Polat C, Dervisoglu A, Senyurek G, Bilgin M, Erzurumlu K, Ozkan K. Umbilical hernia repair with the prolene hernia system. Am J Surg. 2005;190:61–4.CrossRefPubMedGoogle Scholar
  40. 40.
    Khera G, Berstock DA. Incisional, epigastric and umbilical hernia repair using the prolene hernia system: describing a novel technique. Hernia. 2006;10(4):367–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Jacob BP, Hogle NJ, Durak E, Kim T, Fowler DL. Tissue ingrowth and bowel adhesion formation in an animal comparative study: polypropylene versus proceed versus parietex composite. Surg Endosc Other Interv Tech. 2007;21(4):629–33.CrossRefGoogle Scholar
  42. 42.
    Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, et al. Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery [Internet]. 2010;148(3):544–58.  https://doi.org/10.1016/j.surg.2010.01.008CrossRefGoogle Scholar
  43. 43.
    Bondre IL, Holihan JL, Askenasy EP, Greenberg JA, Keith JN, Martindale RG, et al. Suture, synthetic, or biologic in contaminated ventral hernia repair. J Surg Res [Internet]. 2016;200(2):488–94.  https://doi.org/10.1016/j.jss.2015.09.007CrossRefGoogle Scholar
  44. 44.
    Chamieh J, Hui Tan W, Ramirez R, Nohra E, Apakama C, Symons W. Synthetic versus biologic mesh in single-stage repair of complex abdominal wall defects in a contaminated field. Surg Infect (Larchmt). 2017;18(2):112–8.CrossRefGoogle Scholar
  45. 45.
    Schumpelick V, Van Ackeren A, Klinge U. Hernien. Thieme Verlag; 2000. p. 266–7.Google Scholar
  46. 46.
    Chevrel JP, Rath AM. Classification of incisional hernias of the abdominal wall. Hernia. 2000;4(1):7–11.CrossRefGoogle Scholar
  47. 47.
    Korenkov M, Paul A, Sauerland S, Neugebauer E, Arndt M, Chevrel JP, et al. Classification and surgical treatment of incisional hernia: results of an experts’ meeting. Langenbecks Arch Surg. 2001;386(1):65–73.CrossRefPubMedGoogle Scholar
  48. 48.
    Ammaturo C, Bassi G. The ratio between anterior abdominal wall surface/wall defect surface: a new parameter to classify abdominal incisional hernias. Hernia. 2005;9:316–21.CrossRefPubMedGoogle Scholar
  49. 49.
    Dietz UA, Hamelmann W, Winkler MS, Debus ES, Malafaia O, Czeczko NG, et al. An alternative classification of incisional hernias enlisting morphology, body type and risk factors in the assessment of prognosis and tailoring of surgical technique. J Plast Reconstr Aesthet Surg. 2007;60:383–8.CrossRefPubMedGoogle Scholar
  50. 50.
    Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E, et al. Classification of primary and incisional abdominal wall hernias. Hernia. 2009;13:407–14.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Baucom RB, Ousley JM, Oyefule OO, Stewart MK, Holzman MD, Sharp KW, et al. Incisional hernia classification predicts wound complications two years after repair. Am Surg. 2015;81(7):679–86.PubMedGoogle Scholar
  52. 52.
    Russell IT, Devlin HB, Fell M, Glass NJ, Newell DJ. Day case surgery for hernias and haemorrhoids: a clinical, social, and economic evaluation. Lancet [Internet]. 1977;16:844–7. http://www.scopus.com/inward/record.url?eid=2-s2.0-0032528657&partnerID=40&md5=11b8d145708087f437e706d2da98a24eCrossRefGoogle Scholar
  53. 53.
    Arroyo Sebastián A, Pérez F, Serrano P, Costa D, Oliver I, Ferrer R, et al. Is prosthetic umbilical hernia repair bound to replace primary herniorrhaphy in the adult patient? Hernia. 2002;6(4):175–7.CrossRefPubMedGoogle Scholar
  54. 54.
    Brancato G, Donati M, Gandolfo L, Privitera A, Cavallaro G. Organization of a day surgery unit for hernia. Chir Ital. 2003;55(1):65–71.PubMedGoogle Scholar
  55. 55.
    LeBlanc KA, Booth WV. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings. Surg L Endosc. 1993;3(1):39–41.Google Scholar
  56. 56.
    Barlehner E, Schwetling R. Laparoscopic repair of ventral abdominal wall hernias. Zentralbl Chir. 1996;121(4):311–1.Google Scholar
  57. 57.
    Carbajo MA, Martin del Olmo JC, Blanco JI, de la Cuesta C, Toledano M, Martin F, et al. Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh. Surg Endosc. 1999;13:250–2.CrossRefPubMedGoogle Scholar
  58. 58.
    Sauerland S, Walgenbach M, Habermalz B, Cm S, Miserez M. Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Rev. 2011;(3).Google Scholar
  59. 59.
    Carbajo MA, del Olmo JC, Blanco JI, de la Cuesta C, Martin F, Toledano M, et al. Laparoscopic treatment of ventral abdominal wall hernias: preliminary results in 100 patients. J Soc Laparoendosc Surg. 2000;4(2):141–5. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed5&NEWS=N&AN=10917121Google Scholar
  60. 60.
    Morales-Conde S, Cadet H, Cano A, Bustos M, Martin J, Morales-Mendez S. Laparoscopic ventral hernia repair without sutures-double crown technique: our experience after 140 cases with a mean follow-up of 40 months. Int Surg. 2005;90(3 suppl):s56–62.PubMedGoogle Scholar
  61. 61.
    Muysoms F, Vander Mijnsbrugge G, Pletinckx P, Boldo E, Jacobs I, Michiels M, et al. Randomized clinical trial of mesh fixation with “double crown” versus “sutures and tackers” in laparoscopic ventral hernia repair. Hernia. 2013;17(5):603–12.CrossRefPubMedGoogle Scholar
  62. 62.
    Cuccurullo D, Piccoli M, Agresta F, Magnone S, Corcione F, Stancanelli V, et al. Laparoscopic ventral incisional hernia repair: evidence-based guidelines of the first Italian Consensus Conference. Hernia. 2013;17(5):557–66.CrossRefPubMedGoogle Scholar
  63. 63.
    Ramirez OA, Ernesto R, Dellon AL. “Components Separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990;86(3):519–26.CrossRefPubMedGoogle Scholar
  64. 64.
    Caldironi MW, Romano M, Bozza F, Pluchinotta AM, Pelizzo MR, Toniato A, et al. Progressive pneumoperitoneum in the management of giant incisional hernias: A study of 41 patients. Br J Surg. 1990;77:306–7.CrossRefPubMedGoogle Scholar
  65. 65.
    Dumont F, Fuks D, Verhaeghe P, Brehant O, Sabbagh C, Riboulot M, et al. Progressive pneumoperitoneum increases the length of abdominal muscles. Hernia. 2009;13(2):183–7.CrossRefPubMedGoogle Scholar
  66. 66.
    Rodriguez OM, Fernandez LR, Garaulet GP, Rios BR, Jimenez CV, Limones EM. Use of pneumoperitoneum in the repair of giant abdominal hernias. Cir Esp. 2006;80(4):220–3.CrossRefGoogle Scholar
  67. 67.
    Toniato A, Pagetta C, Bernante P, Piotto A, Pelizzo MR. Incisional hernia treatment with progressive pneumoperitoneum and retromuscular prosthetic hernioplasty. Langenbecks Arch Surg. 2002;387(5–6):246–8.CrossRefPubMedGoogle Scholar
  68. 68.
    Hamer DB, Duthie HL. Pneumoperitoneum in the management of abdominal incisional hernia. Br J Surg. 1972;59(5):1960–3.CrossRefGoogle Scholar
  69. 69.
    Appleton ND, Anderson KD, Hancock K, Scott MH, Walsh CJ. Initial UK experience with transversus abdominis muscle release for posterior components separation in abdominal wall reconstruction of large or complex ventral hernias: a combined approach by general and plastic surgeons. Ann R Coll Surg Engl. 2017;4(265–270):265–70.CrossRefGoogle Scholar
  70. 70.
    Oprea V, Radu VG, Moga D. Transversus Abdominis muscle release (TAR) for large incisional hernia repair. Chirurgia. 2016;111(6):535–40.CrossRefPubMedGoogle Scholar
  71. 71.
    Woeste G, Reinisch A, Pession U, Bechstein WO. Wound morbidity in abdominal wall reconstruction can be reduced using transversus abdominis release compared to anterior component separation technique. J Am Coll Surg. 2016;223(4S2):e117–8.Google Scholar
  72. 72.
    Chelala E, Baraké H, Estievenart J, Dessily M, Charara F, Allé JL. Long-term outcomes of 1326 laparoscopic incisional and ventral hernia repair with the routine suturing concept: a single institution experience. Hernia. 2016;20(1):101–10.CrossRefPubMedGoogle Scholar
  73. 73.
    Thomsen CO, Brondum TL, Jorgensen LN. Quality of life after ventral hernia repair with endoscopic component separation technique. Scand J Surg. 2015;105(1):11–6.CrossRefPubMedGoogle Scholar
  74. 74.
    Renard Y, Lardiere-Deguette S, De Mestier L, Appere F, Colosio A, Kianmanesh R, et al. Management of large incisional hernias with loss of domain: a prospective series of patients prepared by progressive preoperative pneumoperitoneum. Surgery. 2016;160(2):426–35.CrossRefPubMedGoogle Scholar
  75. 75.
    Bueno-Lledó J, Torregrosa A, Ballester N, Carreño O, Carbonell F, Pastor PG, et al. Preoperative progressive pneumoperitoneum and botulinum toxin type A in patients with large incisional hernia. Hernia [Internet]. 2017;233–43. http://www.ncbi.nlm.nih.gov/pubmed/28124308%0A; http://link.springer.com/10.1007/s10029-017-1582-2
  76. 76.
    Köckerling F, Berger D, Jost JO. What is a Certified Hernia Center? The example of the German Hernia Society and German Society of General and Visceral Surgery. Front Surg [Internet]. 2014;1(July):1–4. http://www.frontiersin.org/Visceral_Surgery/10.3389/fsurg.2014.00026/abstractGoogle Scholar
  77. 77.
    Helgstrand F, Rosenberg J, Jorgensen LN, Kehlet H, Bisgaard T. Surgical treatment of ventral hernia. UgeskrLaeger. 2010;172:1987–9.Google Scholar
  78. 78.
    Sanders DL, Kingsnorth AN, Windsor ACJ. Is there a role for hernia subspecialists? Or is this a step too far? Hernia. 2016;20(5):637–40.CrossRefPubMedGoogle Scholar
  79. 79.
    Moreno-Egea A, Guzman P, Morales G, Carrillo A, Aguayo JL. Treatment of non-midline ventral hernia: experience in an abdominal wall unit and literature review. Cir Esp. 2007;81(6):330–4.CrossRefPubMedGoogle Scholar
  80. 80.
    Arul GS, Sonka BJ, Lundy JB, Rickard RF, Jeffery SLA. Management of complex abdominal wall defects associated with penetrating abdominal trauma. J R Army Med Corps. 2015;161(1):46–52.CrossRefPubMedGoogle Scholar
  81. 81.
    Iqbal CW, Pham TH, Joseph A, Mai J, Thompson GB, Sarr MG. Long-term outcome of 254 complex incisional hernia repairs using the modified rives-stoppa technique. World J Surg. 2007;31(12):2398–404.CrossRefPubMedGoogle Scholar
  82. 82.
    Gassman A, Mehta A, Bucholdz E, Abthani A, Guerra O, Maclin MMJ, et al. Positive outcomes with negative pressure therapy over primarily closed large abdominal wall reconstruction reduces surgical site infection rates. Hernia. 2015;19:273–8.CrossRefPubMedGoogle Scholar
  83. 83.
    Blackham AU, Farrah JP, Mccoy TP, Schmidt BS, Shen P. Prevention of surgical site infections in high-risk patients with laparotomy incisions using negative-pressure therapy. Am J Surg [Internet]. 2013;205:647–54.  https://doi.org/10.1016/j.amjsurg.2012.06.007CrossRefGoogle Scholar
  84. 84.
    Helgstrand F, Nannestad Jorgensen L. The Danish ventral hernia database—a valuable tool for quality assessment and research. Clin Epidermiol. 2016;8:719–23.CrossRefGoogle Scholar
  85. 85.
    Perira JA, Lopez-Cano M, Hernanadez-Granados P, Feliu X. Initial results of the National Registry of incisional hernia. Cir Esp. 2016;94(10):595–602.CrossRefGoogle Scholar
  86. 86.
    Muysoms F, Campanelli G, Champault GG, DeBeaux AC, Dietz UA, Jeekel J, et al. EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair. Hernia. 2012;16:239–50.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • S. G. Parker
    • 1
  • A. C. J. Windsor
    • 1
  1. 1.Department of Surgery, St Mark’s HospitalNorth London Hospitals NHS TrustHarrowUK

Personalised recommendations