By Michael J. Rosen MD FACS
Atlas of stomach Wall Reconstruction, edited by means of Michael J. Rosen, deals accomplished insurance at the complete variety of stomach wall reconstruction and hernia fix. grasp laparoscopic upkeep, open flank surgical procedure, mesh offerings for surgical fix, and extra with top quality, full-color anatomic illustrations and medical intra-operative photos and movies of approaches played by way of masters. In print and on-line at www.expertconsult.com, this unique atlas presents the transparent counsel you must take advantage of powerful use of either in most cases played and new and rising surgical options for stomach wall reconstruction.
- Tap into the event of masters from video clips demonstrating key moments and methods in belly wall surgery.
- Manage the complete variety of remedies for stomach wall issues with assurance of congenital in addition to obtained problems.
- Get a transparent photo of inner buildings due to fine quality, full-color anatomic illustrations and medical intra-operative photographs.
- Make optimum offerings of surgical meshes with the simplest present info at the variety of fabrics to be had for surgical repair.
- Access the absolutely searchable contents and movies on-line at www.expertconsult.com.
Master as a rule played in addition to new and rising surgical innovations for belly wall reconstruction
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3. Operative Steps 1. Patient Positioning s or the majority of patients with defects in the midline, supine positioning with the F arms tucked works well. The pressure points at the elbow and wrist should be padded (Fig. 2-2). For larger patients, the arm sleds may be required. In patients with defects off the midline or lumbar defects, a bump may be placed under the hip on the side of the hernia, or a true lateral position may be necessary with the aid of a bean bag. Chapter 2 • Laparoscopic Ventral Hernia Repair—Standard 25 Figure 2-2.
Laparoscopic lumbar hernia repair often requires elevation of the ipsilateral side for posterior transabdominal fixation (Fig. 3-5). Usual trocar placement for laparoscopic ventral hernia repair should suffice for initial approach and lysis of adhesions (see Chapter 2, Fig. 2-3). These parts are placed more medially than usual on the contralateral side of the hernia defect. Access to the suprapubic region and myopectineal orifice is facilitated through three trocars at the level of the umbilicus; two are placed just lateral to the linea semilunaris, and one is placed at the umbilicus.
In this instance, an open retrorectus mesh repair may be more beneficial. The ventral defect may be closed during a laparoscopic repair with transabdominal sutures. This technique is usually reserved for defects measuring less than 10 cm in width. s Be cautious of the patient with a history of previous mesh infection! If the prosthetic was contaminated with methicillin-resistant Staphylococcus aureus, an open repair reinforced with a biologic or bioresorbable graft may be preferred. This approach may require a component separation to gain midline closure of the fascia.