Following the appearance of New Jersey reconstructive surgeon Dr. Andrew Elkwood on his patient, Shannon Gatiano, on the network television series, “The Doctors” last spring, the telephones at The Institute for Advanced Reconstruction in Shrewsbury, NJ literally lit up. There were calls from around the country for those seeking to benefit from this innovative procedure. Now is a good time to visit what the topic was about, and to consider our role in getting the word out on the many innovative and potentially life-altering procedures done by the surgeons at The Institute for Advanced Reconstruction.
The BARs Procedure
BARs (Bony Anchored Reinforcement) is a procedure developed by the surgeons at our center. The BARs procedure represents a paradigm shift in the repair of difficult and recurrent hernias; even hernias that have failed many other attempts at repair. The BARs procedure is different in two basic ways. First, an immobile mesh is fixed to the pelvic bone, providing a stable foundation for the repair. Second, the BARs procedure is the first procedure that changes the geometry of the abdominal wall.
Normally, the weight of the abdominal contents are directed downwards into the pelvis, when there is a large hernia, the weight of the contents is often left lying against the repair, which stretches and loosens over time. The Bars procedure directs the weight back into the pelvis, thereby taking the weight off of the repair. It redirects the intra abdominal contents anatomically, down into the pelvis, producing a funnel effect. Pressure is taken off of the pannus. The BARs repair relies upon bony anchoring using Marlex mesh that will not stretch, but helps bolster the laparoscopic repair. The BARs procedure is often combined with a panniculectomy.
The BARS technique after TRAM flap reconstruction provides excellent reinforcement with improved contour and decreased morbidity for the lower abdominal wall. This procedure is used by only a select number of physicians in the country. The BARS technique, although not used widespread, is a great way to provide support for the lower abdominal wall that is weakened through breast reconstruction. This will prove to be very effective in restoring abdominal strength.
See Dr. Andrew Elkwood’s appearance on talk show “The Doctors” to discuss the BARS technique below: