herrera4
Guru
i have an op note that i think may be more than an incisional hernia...
....... Abdomen was entered through a small vertical incision at the apex of the previous incision. The visual trocar was inserted and no enterotomies were encountered. Visualization was excellent. Additional ports were placed in the right upper quadrant as well as the left lower, left mid abdomen. Using two-handed dissection, the adhesions to the abdominal wall which were primarily omental were taken down using the LigaSure device. This allowed us to eventually identify the ileostomy site where large line approximately 20 cm of small bowel oriented inferiorly and medially to the ileostomy and this was carefully freed using sharp and LigaSure dissection. The small bowel was delivered intact without enterotomy to the abdominal cavity. It became apparent that there was a large lateral mesenteric defect involving the ileostomy. Pursestring suture was then placed in transverse orientation to close the ileostomy defect laterally by taking bites of the peritoneum to the mesentery. This was accomplished using intracorporeal suture technique and this allowed for complete closure of the defect. The 10 x 10 cm Allomax mesh was then fashioned with a central 3 cm defect created to allow for complete closure. This was actually a 10 x 20 cm piece of mesh. The mesh was hydrated, oriented, placed in abdominal cavity and placed so that the tails of the mesh were oriented laterally. Initially, we attempted to use the secure strap to secure the mesh. However, the tack would not penetrate the bioprosthesis. Accordingly, the ProTack device was used to tack the mesh around the ileostomy. The mesh lie flat without wrinkles......
thanks for any help
....... Abdomen was entered through a small vertical incision at the apex of the previous incision. The visual trocar was inserted and no enterotomies were encountered. Visualization was excellent. Additional ports were placed in the right upper quadrant as well as the left lower, left mid abdomen. Using two-handed dissection, the adhesions to the abdominal wall which were primarily omental were taken down using the LigaSure device. This allowed us to eventually identify the ileostomy site where large line approximately 20 cm of small bowel oriented inferiorly and medially to the ileostomy and this was carefully freed using sharp and LigaSure dissection. The small bowel was delivered intact without enterotomy to the abdominal cavity. It became apparent that there was a large lateral mesenteric defect involving the ileostomy. Pursestring suture was then placed in transverse orientation to close the ileostomy defect laterally by taking bites of the peritoneum to the mesentery. This was accomplished using intracorporeal suture technique and this allowed for complete closure of the defect. The 10 x 10 cm Allomax mesh was then fashioned with a central 3 cm defect created to allow for complete closure. This was actually a 10 x 20 cm piece of mesh. The mesh was hydrated, oriented, placed in abdominal cavity and placed so that the tails of the mesh were oriented laterally. Initially, we attempted to use the secure strap to secure the mesh. However, the tack would not penetrate the bioprosthesis. Accordingly, the ProTack device was used to tack the mesh around the ileostomy. The mesh lie flat without wrinkles......
thanks for any help