VENTRAL HERNIA

LAPAROSCOPIC
 10-mm videoscope port (0) and the 5-mm operating ports (X)
 One o the operating ports should be 10 mm in size i a 5-mm videoscope is not available

Zollinger, R. M., Zollinger, R. M., & Zollinger, R. M. (2003). Zollinger's atlas of

surgical operations. New York: McGraw-Hill, Medical Pub. Division.
 The videoscope port is placed rst, using the open Hasson technique
 The omentum is grasped near the abdominal wall with the forceps or the dissecting instrument and gentle traction
is applied.
 Using laparoscopic scissors, the surgeon sharply incises the junction o the omentum with the peritoneum of the
abdominal wall

Zollinger, R. M., Zollinger, R. M., & Zollinger, R. M. (2003). Zollinger's atlas of

surgical operations. New York: McGraw-Hill, Medical Pub. Division.
 After each cut, a sweeping motion in the same area will open up the next zone or cutting.
 Electrocautery or other heat-generating coagulating systems should be used sparingly and only with full
visualization
 After the abdominal wall adhesions are taken down, the omentum is removed rom the hernial sac, which is let
intact.

Zollinger, R. M., Zollinger, R. M., & Zollinger, R. M. (2003). Zollinger's atlas of

surgical operations. New York: McGraw-Hill, Medical Pub. Division.
 gentle traction is applied to the omentum while the surgeon spreads, cuts, and sweeps.
 lower the intraabdominal CO2 gas pressure to about 6 or 8 mm Hg
 measurements of the defect are made with the abdomen fully inflated at 15 mm Hg, the mesh will be too large.
 It will become very wrinkled and loose when the CO2 is removed at the end of the operation

Zollinger, R. M., Zollinger, R. M., & Zollinger, R. M. (2003). Zollinger's atlas of

surgical operations. New York: McGraw-Hill, Medical Pub. Division.
 A long needle is passed perpendicularly at the edge of the ascial defect in each o the our quadrants.
 The entrance site at the internal edge of the hernial defect is verified with the videoscope and the external sites are
marked with indelible ink.
 defect is outlined so as to determine the size and shape o the mesh.
 A 3- to 4-cm margin is drawn out rom this defect.
 choosing the mesh’s size and shape

Zollinger, R. M., Zollinger, R. M., & Zollinger, R. M. (2003). Zollinger's atlas of

surgical operations. New York: McGraw-Hill, Medical Pub. Division.
 The dual-sided mesh is prepared one in each quadrant
 The sutures are nonabsorbable 00 in size and may be placed with parallel or perpendicular to the edge o the mesh.
 A useful maneuver is to use a pair of parallel sutures in one axis (12 and 6 o’clock) and perpendicular sutures in
the other axis (3 and 9 o’clock).

Zollinger, R. M., Zollinger, R. M., & Zollinger, R. M. (2003). Zollinger's atlas of

surgical operations. New York: McGraw-Hill, Medical Pub. Division.
 In this manner, the axis or internal attachment is identified when the mesh is not round in shape.
 Each suture is tied in its midpoint and the long tails are let intact. The mesh is rolled snugly with the nonadherent
surface inside and synthetic mesh outside, so as not to create tension that may peel the two layers apart

Zollinger, R. M., Zollinger, R. M., & Zollinger, R. M. (2003). Zollinger's atlas of

surgical operations. New York: McGraw-Hill, Medical Pub. Division.
 Upon completion o the procedure, the abdomen is lavaged with the suction irrigator.
 Careful inspection is made or any bleeding sites and bile or succus.
 Each of the operating ports is removed

Zollinger, R. M., Zollinger, R. M., & Zollinger, R. M. (2003). Zollinger's atlas of

surgical operations. New York: McGraw-Hill, Medical Pub. Division.
REFERENCE

 Zollinger, R. M., Zollinger, R. M., & Zollinger, R. M. (2003). Zollinger's atlas of surgical operations. New
York: McGraw-Hill, Medical Pub. Division.