Laparoscopic Repair of Incisional Hernia in patient with severe adhesion
March 10th, 2013
The treating patients with incisional hernia is constantly on the test the skill and judgment of a qualified laparoscopic surgeons. The typical open way of incisional hernia repair has produced unsatisfactory outcomes. Using the excessive morbidity, long stay in hospital and unacceptably high recurrence rates that plague the traditional open method of incisional hernia, a different as laparoscopic repair of incisional hernia is needed
All patients received an mechanical bowel preparation preoperatively to decrease the chance of perfforation. Prophylaxis antibiotics for wound infection and deep vein thrombosis were utilised routinely in case of laparoscopic repair of incisional hernia. The individual for laparoscopic surgery should be catheterized and positioned supine with both arms tucked in at the sides. Nasogastric tube insertion is necessary to introduce the port to palmer's point.
The camera port is inserted as laterally as you can at palmer's point secretly estimated to achieve the greatest distance through the abdominal wall defect usually palmer's point. Two or one working ports are put just over the level of the camera port and so on either side or only 1 port on lateral side may be used. All abdominal wall adhesions are divided with scissors and cautery. The falciform ligament can often be mobilized in the anterior abdominal wall. Care should be taken if you use electrocautery to prevent inadvertent bowel injury. The whole part of abdominal wall defects are identified and measured internally with the umbilical tape marked at 2-cm increments. The right sized mesh is chosen, allowing at least 6 cm overlap on the sides
The mesh is oriented and centred around the defect, as well as the transabdominal anchoring sutures are situated with a Gore Suture Passer. The sutures are tied, along with the regarding the mesh is secured with spiral tacks at 1-cm intervals. Additional tacks are positioned centrally in large mesh applications. The pneumoperitoneum is reduced from 15 mm Hg to 10 mm Hg, so your sutures are tied in the tension-free manner.
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