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Procedure(s): Laparoscopic converted to open lysis of adhesion with extraction of infected abdominal wall mesh with resection of mesh appendical fistula with appendectomy with closure of midline ventral hernia
After prepping and draping the patient, a midline incision was made below the umbilicus. This incision was carried down through the fascia. The adhesions were lysed to exposed the peritoneal cavity and a gel port was placed. The laparoscopic instruments were inserted and the density of adhesions made the mobilization of bowel impossible. The gel port was removed and the incision was carried proximally to resect the fistula and open the skin to just above the umbilicus. The incision was from the umbilicus to the pubic bone.
The infected mesh was removed to a point where there was a portion of the bowel entering the mesh this was divided with a GIA staple. This was tagged. Eventually the mesh was completely removed.
With extensive lysis of adhesions the cecum was mobilized and the site of division of the GIA was found to be the appendix. The site was involuted into the cecum with interrupted vicryl sutures.
The remaining area was lyse of adhesion and then the hernia was addressed.
The hernia extended to the xiphoid and was closed with a running looped PDS to the pubic bone.
Procedure(s): Laparoscopic converted to open lysis of adhesion with extraction of infected abdominal wall mesh with resection of mesh appendical fistula with appendectomy with closure of midline ventral hernia
After prepping and draping the patient, a midline incision was made below the umbilicus. This incision was carried down through the fascia. The adhesions were lysed to exposed the peritoneal cavity and a gel port was placed. The laparoscopic instruments were inserted and the density of adhesions made the mobilization of bowel impossible. The gel port was removed and the incision was carried proximally to resect the fistula and open the skin to just above the umbilicus. The incision was from the umbilicus to the pubic bone.
The infected mesh was removed to a point where there was a portion of the bowel entering the mesh this was divided with a GIA staple. This was tagged. Eventually the mesh was completely removed.
With extensive lysis of adhesions the cecum was mobilized and the site of division of the GIA was found to be the appendix. The site was involuted into the cecum with interrupted vicryl sutures.
The remaining area was lyse of adhesion and then the hernia was addressed.
The hernia extended to the xiphoid and was closed with a running looped PDS to the pubic bone.