1 / 12

Endoscopic Components Separation and Seroma Management

Endoscopic Components Separation and Seroma Management. Gina L. Adrales MD, MPH, FACS Associate Professor Dartmouth Medical School Dartmouth-Hitchcock Medical Center. Endoscopic Components Separation Technique (CST).

colin-leonard
Download Presentation

Endoscopic Components Separation and Seroma Management

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Endoscopic Components Separation andSeroma Management Gina L. Adrales MD, MPH, FACS Associate Professor Dartmouth Medical School Dartmouth-Hitchcock Medical Center

  2. Endoscopic Components Separation Technique (CST) • Combines technology and technique learned from minimal access surgery with open (or increasingly laparoscopic) complex hernia repair • Aimed to reduce the morbidity associated with the large skin flaps of the open approach to Components Separation

  3. Endoscopic CST • Lowe described an endoscopically assisted CST for abdominal wall closure in 2000 • Rosen et al 2007 • Porcine model endoscopic CST-achieved 86% advancement of open approach with reduction of wound complications to 14% Lowe JB et al. Plast Reconstr Surg 2000;105:720-30 Rosen MJ et al. Am J surg 2007;194:385-9

  4. Endoscopic CST • University of KY group presented retrospective series of open CST to endoscopic CST • Lower wound complications in endo group (9 v 57%) • Very short follow up of mean 4 months (1-12 m), no recurrences

  5. Endoscopic CST:Applicability • Same indications as open CST • Do not use when plan to excise scar widely/laterally

  6. Endoscopic CST:Technique • Arms tucked • Subcostal cutdown small transverse incision in the far lateral abdomen to ensure away from semilunar line • Exposure of the external oblique aponeurosis

  7. Endoscopic CSTTechnique • Grasp external oblique fascia and elevate and incise • Develop bluntly the space between the external and internal • Place balloon dissector and inflate with camera visualization

  8. Endoscopic CSTTechnique • Additional one to two 5mm ports lateral to linea semilunaris • Exposure of the external oblique aponeurosis lateral and parallel to the linea semilunaris • Vertical incision of external oblique aponeurosis to inguinal ligament and superiorly to costal margin

  9. Endoscopic CSTTechnique • For full release • Divide muscular portion above costal margin • Release Scarpa’s fascia • Careful hemostasis is needed due to limited exposure • Must stay well lateral to semilunar line to avoid disruption of the internal oblique aponeurosis and lateral herniation

  10. Seroma prevention and management • Careful tissue handling • Avoidance of wide thermal injury • Preservation of perforating vessels • Prevention techniques • Excision of hernia sac, cautery of sac • Closure of dead space • Talc instillation’ • External pressure

  11. Seroma prevention and management • Open repair • Suprafascial drain placement, continued until low output • Laparoscopic repair • Various techniques have been tried as previously outlined with sac excision, cautery of sac • Inevitable seroma formation and expected to be temporary so patient education is key • Abdominal binder

  12. Seroma prevention and management • Longstanding seroma • Image-guided drainage • May require laparoscopic drainage and resection of pseudocapsule

More Related