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

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Laparoscopic Ventral Hernia Repair Case
PresentationVisiting Professor James C.
Gruenberg, MD

• Boris Vinogradsky, MD
• Department of Surgery
• Medical College of Ohio
• May 23, 2002

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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

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Laparoscopic Ventral Hernia Repair

• Meds ASA, Norvasc, Zestril
• Allg Cipro
• Soc Hx Tob 60 pack/years, EtOH
• Fam Hx Father _at_ 65 MI, he also had 2 IHRs,
  mother _at_ 77 - DM, MI

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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

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Laparoscopic Ventral Hernia Repair

• Open technique

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Laparoscopic Ventral Hernia Repair

• Port placement for standard midline ventral
  hernia repair

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Laparoscopic Ventral Hernia Repair

• Port placement
• Direct visualization
• Controlled insertion
• Bowel protection

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Laparoscopic Ventral Hernia Repair

• Adhesiolysis
• Blunt
• With instruments

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Laparoscopic Ventral Hernia Repair

• After dissection was completed

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Laparoscopic Ventral Hernia Repair

• 1. Gore-Tex
• 2. Teflon
• 3. Surgipro
• 4. Marlex
• 5. Prolene
• 6. Mersilene

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Laparoscopic Ventral Hernia Repair

• Use of T-fasteners technique

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Laparoscopic Ventral Hernia Repair

• Gore-Tex mesh placement

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Laparoscopic Ventral Hernia Repair

• Stapling

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Laparoscopic Ventral Hernia Repair

• Stapling

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Laparoscopic Ventral Hernia Repair

• Approximate mesh size used for repair

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Laparoscopic Ventral Hernia Repair
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Laparoscopic Ventral Hernia Repair

• Complications
• Seroma formation (6)
• Port site infection (3)
• Bowel perforation mechanical or thermal injury
  (0.5)
• Recurrence (3)

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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!!!

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Laparoscopic Ventral Hernia Repair
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Laparoscopic Ventral Hernia Repair
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Laparoscopic Ventral Hernia Repair