Laparoscopic spigelian herniorraphy - general and visceral surgery
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Positioning, skin incision, pneumoperitoneum
Position patient supine on OR Table, skin prep and drape (sterile!): Entire abdomen from costal arches to symphysis pubis. Incise skin on opposite side of hernia and enter abdomen in open fashion. Bluntly insert the 10 mm trocar and accomplish the pneumoperitoneum with an intra-abdominal pressure of about 12-15 mmHg.
Note:
It is up to the surgeon how he/she gains access to the abdomen. Open access is preferred. Because of numerous unnoticed injuries with at times lethal outcome, medical experts in legal proceedings have become more and more wary of the Verres needle.
Inserting the laparoscope and working trocars
Insert the laparoscope with the camera and inspect for possible injury and bleeding: In particular, carefully check for any adhesions in the immediate vicinity. Laparoscopic overview: Inspect all organs and look out for any pathologies. Insert the first 5 mm trocar. Always do this under visual camera control to minimize any risk of injury. The surgeon will determine the exact location based on his/her experience and preference. The second 5 mm working trocar will be inserted later on.
Inspecting the hernia orifice
Determining the size and position of the hernia orifice
Choosing the best mesh size
Mesh positioning
Mesh fixation
Trimming the stay sutures, removing the trocars, bleeding off the pneumoperitoneum
Fascia sutures, skin sutures, dressing
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