By Michael J. Rosen MD FACS
Atlas of belly Wall Reconstruction, edited through Michael J. Rosen, deals entire assurance at the complete diversity of stomach wall reconstruction and hernia fix. grasp laparoscopic maintenance, open flank surgical procedure, mesh offerings for surgical fix, and extra with fine quality, full-color anatomic illustrations and scientific intra-operative pictures and video clips of techniques played through masters. In print and on-line at www.expertconsult.com, this specified atlas presents the transparent tips you want to take advantage of powerful use of either generally played and new and rising surgical innovations for stomach wall reconstruction.
- Tap into the adventure of masters from video clips demonstrating key moments and methods in stomach wall surgery.
- Manage the entire variety of remedies for stomach wall issues with assurance of congenital in addition to received problems.
- Get a transparent photo of inner constructions due to top quality, full-color anatomic illustrations and medical intra-operative photographs.
- Make optimum offerings of surgical meshes with the easiest present info at the variety of fabrics on hand for surgical repair.
- Access the totally searchable contents and video clips on-line at www.expertconsult.com.
Master as a rule played in addition to new and rising surgical options for stomach wall reconstruction
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Extra info for Atlas of Abdominal Wall Reconstruction
After tack fixation at the periphery of the mesh, additional permanent, monofilament sutures are placed every 5 to 7 cm around the circumference of the mesh (Fig. 2-16). Large defects require more frequent sutures; smaller, “Swiss cheese”–type defects may need fewer. s Before completion of the case, one last inspection of the abdominal cavity is performed to rule out continued bleeding. The fascia at trocars larger than 5 mm should be closed with suture in this hernia-prone population. The skin at the trocar sites is closed with subcuticular stitches, followed by skin tapes or tissue cyanoacrylate.
Mesh fixation Hernia sac area above mesh Costal margin A B Inferior aspect of liver Figure 3-13. Area of pericardium above mesh Omental fat Adequate mesh overlap draped over diaphragm 56 Section II • Laparoscopic Repairs Cephalad suture placed several cm off edge of mesh Costal margin Figure 3-14. Cut edge of peritoneum Lumbar hernia A B Retroperitoneal fat Psoas muscle Figure 3-15. Right kidney Inferior aspect, right lobe of liver Chapter 3 • Laparoscopic Repair of Atypical Hernias: Suprapubic, Subxiphoid, and Lumbar 57 Perinephric fat Lumbar hernia Tendinous insertion of psoas muscle Right kidney Psoas Psoas A B Inferior aspect, right lobe of liver Ureter Inferior vena cava Figure 3-16.
It is important to maintain the proper orientation of the mesh. It may be helpful with larger pieces to mark a line across the horizontal axis of the mesh before insertion to ensure that the line runs from side-to-side. Chapter 2 • Laparoscopic Ventral Hernia Repair—Standard 33 LARGE MESH PULLED THROUGH FROM CONTRALATERAL SIDE GRASPER Figure 2-10. Figure 2-11. 34 Section II • Laparoscopic Repairs 6. Securing the Mesh s fter unrolling the mesh, retrieve the cardinal suture at the vertical site where there is the A least amount adjustment first.