Surgical Case #32 Operative Report Preoperative Diagnosis: Ventral hernia Postop

Question

Surgical Case #32 Operative Report Preoperative Diagnosis: Ventral hernia Postoperative Diagnosis: Ventral hernia Operation Performed: Laparoscopic repair of ventral hernia Anesthesia: Details of Procedure: The patient was taken to the operating room, placed in the General supine position. The abdomen was prepped and draped in the usual sterile fashion. A Veress needle was then inserted in the left lateral abdominal wall. The abdomen was insuflated with CO, gas. A 10-mm Surgiport was then placed. The laparoscopic camera was then inserted. Additional 5-mm Surgiports were placed under direct vision, one in the left lower quadrant of the abdomen, the other in the left upper quadrant of the abdomen. The 5-mm harmonic scalpel was used along with the dissecting forceps to take down the adhesions from within and around the hernia sac. There were a number of adhesions, primarily involving the omentum. These were all removed. Two hernia defects were noted, one just above the umbilicus, per- haps 3 to 4 cm in diameter, and another toward the upper aspect of the midline incision, that had not been previously recognized. It was elected to place an 18 3 24-cm segment of Gore-Tex dual mesh. #1 Prolene was sewn at each of the corners of this as well as in between, at the midpoint of each of the sides. Suit- able locations were chosen for tying the anchoring sutures. The patch then was rolled around a grasper and inserted into the abdominal cavity through the 10-mm port. The patch was then unrolled and the orientation placed with the smooth side down against the bowel. An endoclose device was used to grasp of the sutures and bring out through the previously placed inci- sions for the anchoring sutures. The patch was anchored at each of the six locations as noted previously. Then, an auto suture Protac was placed around the periphery of the patch. Additional staples were placed within the inner aspect of the patch using an Ethicon tacking stapler. The patch was noted to be quite taut and applied closely to the abdominal wall to prevent any movement of the patch. The abdomen was then desufflated and the ports withdrawn. Each of the skin incisions was closed with 4-0 clear PDS subcuticular suture and Steri-Strips. Tegaderm dressings were then applied. The patient tolerated the procedure well with no apparent difficulty. She was then taken to the postanesthesia recovery room for further postoperative care. each Code(s): Index entries

Explanation / Answer

Laparoscopic hernia repair

49651 - laparoscopy, surgical, repair, ventral, umbilical or epigastric hernia

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