Wiki there is no easy hernia repair to me...

herrera4

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Wallingford, CT
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i seem to always have trouble with abdominal hernia repirs

OPERATIVE FINDINGS: Included approximately 3 cm separation of the rectus muscles from the xiphoid to the umbilicus. There was incarcerated preperitoneal fat. There was a small umbilical hernia defect. There was excellent coverage of the defect of overlap of the fascia by 5 cm on either side. The midline closure was attachment free, having been bridged by the mesh.
DETAILS OF THE PROCEDURE: The patient was brought to the operating room and placed in supine position. Following induction of general anesthesia, he was prepped and draped in the usual sterile fashion using ChloraPrep. After infiltration of local anesthetic, a vertical midline incision was made just approximately 6 cm. This was carried down through the skin and the subcutaneous tissue. Bleeding points controlled with cautery. The fascia was incised using cutting cautery and the edges were elevated. Renal attachments in the preperitoneal space was swept away. The peritoneal cavity was entered. The skin flaps were then elevated approximately 4.5 cm around the circumference of the incision to allow for attachment free closure. The fascia was noted to be quite attenuated in the midline. At the level of the umbilicus, umbilical skin was elevated from the fascia and the incarcerated umbilical fat was excised and passed off the field. The 20 x 15 cm rectangular mesh was cut for repair. It was hydrated and placed in the abdominal cavity on top of the preperitoneal fat and omentum. This was deployed without wrinkles and tacked at the 12 and 6 o'clock positions with the SecureStrap tacker followed by tacks laterally after reattaching the fascia to essentially bridge the fascia with the mesh. Once this was accomplished, multiple sutures of 0 PDS were placed to further fix the mesh and the fascia. Following this, running #1 Prolene was used to approximate the rectus muscles without tension followed by another layer of 0 Prolene to further imbricate the anterior sheath over the repair. PLease not that the mesh had been rinsed with Ancef solution. A #10 Jackson-Pratt drain was then brought out through a separate stab wound in left lower quadrant and secured to the skin with silk sutures. The subcutaneous was approximated using 3-0 Vicryl followed by subcuticular 4-0 for the skin. This was followed by Steri-Strips, dry sterile dressing, and Tegaderm. The patient tolerated the procedure well and was brought back to the recovery room in stable condition.
 
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