Perioperative management - Ramirez component separation technique - general and visceral surgery
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Indications
Complex incisional hernia:
- Incisional hernia with abdominal wall defect:
- Giant hernia, extra-abdominal organ displacement (“loss of domain”)
- Inevitable abdominal wall hernia (herniation after laparostomy)
- Partial loss of the abdominal wall and/or skin cover - Recurrent incisional hernia:
- Following previous direct suture repair
- Following mesh augmentation (herniation at edge of mesh, rupture or torn out mesh)
- Following flap transfer (denervation, donor defect)
- Multiple recurrences
- Incisional hernia with abdominal wall defect:
- Giant hernia, extra-abdominal organ displacement (“loss of domain”)
Contraindications
- Superficial and deep skin infection, pressure sores
- Severe cirrhosis of the liver with ascites
- Respiratory infection
Preoperative diagnostic work-up
- Medical history
- Asking the patient to elevate the upper trunk allows good assessment of the surrounding muscles and the size of the fascial defect.
- Ultrasonography
- CT or MRI
- Pulmonary function testing and echocardiography, depending on the patient’s morbidity
Special preparation
Preoperative pneumoperitoneum for abdominal wall conditioning:
At least 10 days before the planned surgery insert a single-lumen central venous catheter through a trocar into the intraperitoneal space. Over a period of 10 days, insufflate 1 liter of ambient air per day into the abdominal cavity, thereby expanding the abdominal wall.
Informed consent
General risks as in any other surgical procedure:
- Bleeding
- Secondary bleeding
- Hematoma
- Thrombosis
- Embolism
- Injury to adjacent structures such as nerves, vessels, bladder, and intestines
- Impaired intestinal passage (atony/ileus)
- Secondary healing
- Infection and abscess
Special risks:
- Limited movement
- Chronic pain
- Wound seroma
- Mesh migration
- Mesh infection
- Mesh rupture
- Recurrence
Anesthesia
Positioning
Operating room setup
Special instruments and fixation systems
Postoperative management
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