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Laparoscopic Ventral Hernia Repair Case Presentation Visiting Professor: James C. Gruenberg, MD

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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Laparoscopic Ventral Hernia Repair Case Presentation Visiting Professor: James C. Gruenberg, MD

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    1. Laparoscopic Ventral Hernia Repair Case Presentation Visiting 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

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