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Takedown of falciform ligament & removal of peritoneal lining of umbilicus with open

ksb0211

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Takedown of falciform ligament & removal of peritoneal lining of umbilicus with open

Oh my. This case is giving me a headache. Any insight would be unbelievably appreciated.

................I made a 5 mm incision in the left upper quadrant through a previous incision site into the abdomen with a Veress needle, insufflated 14 mmHg, placed a 5 mm port. There was some adhesions down above the umbilicus, placed a port in the left lower quadrant and one in the right upper quadrant through previous incision sites, got in, took down those adhesions and then looked at the falciform ligament, we used a laparoscopic Metzenbaum to take down the falciform ligament, mobilizing it, placed a 22-gauge needle through the umbilicus, identifying which was then cleaned off the peritoneum in that area. Once that was done, we placed traction on the umbilicus, found a small fistulous tract and opened that track up with the Bovie as well. There was essentially no blood loss to speak of. We closed all wounds with running subcuticula sutures of 4-0 Vicryl and placed a sterile dressing in the umbilicus.
 
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