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Laparoscopic Ventral Hernia Repair. 63 yo wm presented to MCO General Surgery clinic for evaluation of abdominal herniaComplaints of vogue abdominal pain and discomfortPMHx:CAD, HTN, PVDPSHx:Appy '65, AAA 97. Laparoscopic Ventral Hernia Repair. Meds:ASA, Norvasc, ZestrilAllg:CiproSoc
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1. Laparoscopic Ventral Hernia Repair Case PresentationVisiting Professor: James C. Gruenberg, MD Boris Vinogradsky, MD
Department of Surgery
Medical College of Ohio
May 23, 2002
2. Laparoscopic Ventral Hernia Repair 63 yo wm presented to MCO General Surgery clinic for evaluation of abdominal hernia
Complaints of vogue abdominal pain and discomfort
PMHx: CAD, HTN, PVD
PSHx: Appy 65, AAA 97
3. Laparoscopic Ventral Hernia Repair Meds: ASA, Norvasc, Zestril
Allg: Cipro
Soc Hx: Tob 60 pack/years, EtOH
Fam Hx: Father @ 65 MI, he also had 2 IHRs, mother @ 77 - DM, MI
4. Laparoscopic Ventral Hernia Repair PE: Chest CTA Heart RRR, no murmurs Abd soft, NT, ND, large ventral defect in upper midline 5x15 cm Ext no edema Neuro AAA, intact
5. Laparoscopic Ventral Hernia Repair Open technique
6. Laparoscopic Ventral Hernia Repair Port placement for standard midline ventral hernia repair
7. Laparoscopic Ventral Hernia Repair Port placement:
Direct visualization
Controlled insertion
Bowel protection
8. Laparoscopic Ventral Hernia Repair Adhesiolysis
Blunt
With instruments
9. Laparoscopic Ventral Hernia Repair After dissection was completed
10. Laparoscopic Ventral Hernia Repair 1. Gore-Tex
2. Teflon
3. Surgipro
4. Marlex
5. Prolene
6. Mersilene
11. Laparoscopic Ventral Hernia Repair Use of T-fasteners technique
12. Laparoscopic Ventral Hernia Repair Gore-Tex mesh placement
13. Laparoscopic Ventral Hernia Repair Stapling
14. Laparoscopic Ventral Hernia Repair Stapling
15. Laparoscopic Ventral Hernia Repair Approximate mesh size used for repair
16. Laparoscopic Ventral Hernia Repair
17. Laparoscopic Ventral Hernia Repair Complications:
Seroma formation (6%)
Port site infection (3%)
Bowel perforation mechanical or thermal injury (0.5%)
Recurrence (3%)
18. Laparoscopic Ventral Hernia Repair Pearls: 1. Place all ports as far away from the defect as possible 2. Switch scope position 3. Keep intraabdominal pressure HIGH during dissection and LOW during closing 4. MARK THE MESH!!!
19. Laparoscopic Ventral Hernia Repair
20. Laparoscopic Ventral Hernia Repair
21. Laparoscopic Ventral Hernia Repair