Ventral Hernia Flashcards
1
Q
Laparoscopic VHR
A
- Entry into abdomen via optical trocar in Palmar’s point.
- Placement of 5 mm (2 on each side) 4 cm lateral to defect.
- Adhesiolysis and exposure of lateral edges of fascia.
- Reapproximation of fascia via shoe-string technique with Carter-Thomason PDS sutures.
- Placement of coated mesh to allow for 4-5 cm of overlap.
- Tacking of mesh laterally with 5 mm circular tacker with 2 cm between each tack, beginning on one side and working circumferentially around.
- Desufflate abdomen to ensure proper placement of mesh without tension.
- Remove ports.
2
Q
Transversus abdominus release/VHR
A
- Midline incision with removal of all previous mesh and adhesiolysis of all abdominal wall to paracolic gutters.
- Incision of posterior rectus sheath 2 cm from rectus sheath medially, entering the posterior rectus space.
- Dissect retro-rectus space laterally to linea semilunaris.
- Incise LS and transversus abdominus muscle to enter preoperitoneal space. Develop plan laterally to psoas muscle on both sides.
- Re-approximate posterior fascia with absorbable suture.
- Placement of large light-weight polypropylene mesh allowing for 5 cm of overlap. Placement of drains over mesh.
- Re-approximate anterior rectus sheath with figure of 8, 0 PDS sutures.
- Skin closure.
3
Q
Takedown of Enterocutaneous fistula
A
- Allow 1 year of healing
- Safe entry into abdomen
- Extensive adhesiolysis to exposure bowel loops.
- Inspection of bowel viability, resection if needed.
- Abdominal irrigation, closure of abdominal wall.
