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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1048_Библиотеки_им_академика_М_И_Перельмана
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Fig. 8.1: Spigelian hernia with omentum in the defect.
Spigelian Hernia
71
Fig. 8.2: Releasing the omentum from the defect.
After the hernia contents are reduced if the size of defect is more than
3 cm, then there is no need to suture the defect from inside. Size of defect
is calculated and mesh size is selected. For 3 cm defect we need to use
at least 15 × 15 size mesh.
Mesh is rolled and pushed inside from 12 mm port (Fig. 8.4).
All four corners of mesh suture are tied for transfascial ligation of mesh.
Rest of mesh is xed by tackers (Figs. 8.5 to 8.7).
Mesh is xed by double crown technique (Figs. 8.8 and 8.9).
72
Laparoscopic Hernia Surgery
Fig. 8.3: Spigelian hernia after reduction of omental contents.
Fig. 8.4: Introduction of tissue separation mesh.
Fig. 8.5: Technique of Transfascial ligation of mesh.
Fig. 8.6: Technique of taking 2nd suture with Cobbler’s needle.
Spigelian Hernia
73
Fig. 8.7: Both sutures taken through anterior abdominal wall.
Fig. 8.8: Fixation of mesh with xation device.
74
Laparoscopic Hernia Surgery
Fig. 8.9: Double crown technique.
LAPAROSCOPIC TAPP TECHNIQUE
A transverse cut is made, starting from 5 cm from lateral edge of the defect
and extending up to a point 7 cm medial to the edge of the defect. Where
it approaches the defect, the peritoneal incision curves downward toward
the edge of the defect. en the peritoneal ap is extensively raised above
and below until the edge of the defect is completely exposed all around.
e dissection proceeds for about 7 cm superiorly and 7–10 cm inferiorly.
e inferior is extent of the dissection is taken up to the pubic ramus
and extended laterally as it is done for TAPP hernia.
When the peritoneal closure is completed the entire defect is been
covered with polypropylene mesh and no part of the mesh is visible to
the telescope from the peritoneal cavity, thus avoiding the possible trap of
adhesion.
Page numbers followed by f refer to gure.
Index
A
Air knotting 56f
Allis forceps 16
Anterior rectus sheath 16
Appendix 42
B
Bard Syntack 68
Bowel enterotomy 47
C
Camper’s and Scarpa’s
fasciae 6
Capno dissection 29f
Cobbler’s needle 73f
Collagen bers 65
Collagen hydrogel 63
Cooper’s ligament 1
Corona mortis 9
D
Defect surface area 42
Double crown technique 58f
Drain placement 40f
F
Fatty apron 38
Femoral nerve 10
Fixation of mesh with xation
device 73f
Flabby abdomen 38f
Fossae 4
lateral umbilical fossa 4
medial umbilical fossa 4
supravesical fossa 4
H
Harmonic scalpel 48f
Hasselbach’s triangle 1
Hernia repairs 42
I
Ilioinguinal nerve 11
Iliopubic tract 27
Iliopubic vein 9
Incisional hernia 46
9 suture technique 50
advantage 51
disadvantages 51
Garland technique 54
intraperitoneal suture technique 51
advantage 51
disadvantage 51
partially sutured technique 54
tacker technique 56
technique 46
cost-eective analysis 49
ports 46
Infraumbilical incision 15f
Intraperitoneal onlay mesh 70
L
Laparoscopic intraperitoneal onlay
mesh plasty 70
Laparoscopic TAP P technique 74
Laparoscopic ventral hernia mesh
plasty 38
Laparoscopic ventral hernia mesh
plasty rationale 44
Laparoscopic ventral hernia repair 42
Lateral femoral cutaneous nerve 10
Lighthouse sign 19f
G
Gallbladder 42
Genitofemoral nerve 10
M
Maryland’s forceps 27, 30
Mesh xation by tackers 58f
76
Laparoscopic Hernia Surgery
Mesh repair 39f
Meshes in laparoscopic ventral
hernia repairs 62
properties 62
macroporosity 62
mesh shrinkage 62
microporosity 62
molecular weight of meshes 63
types 63
ParietexTM composite mesh
(Covidien) 63
Proceed® mesh (Ethicon) 64
SeprameshTM (Bard) 63
Myopectineal orice of Fruchaud 2
N
Neoumbilicus 40f
O
Onlay mesh plasty 44f
Origin of the hernia 1
Oxidized regenerated cellulose 64
P
Palmer’s point 46f
Paracolostomy 42
Paraileostomy 42
Paraumbilical hernia 46
Parietex composite 70
Peritoneal landmarks from the inside 3
lateral umbilical ligament 4
medial umbilical ligament 3
median umbilical ligament 3
Peritoneum 43f
PMS stapler 45
Polydioxanone suture 64
Polypropylene meshes 45
Polyvinyl chloride 64
Post rectus sheath 43f
Preperitoneal space 4
bilaminar transversalis fascia 6
Dulucq’s space 8
iliopectineal arch 7
iliopubic tract 6
space of Bogros 8, 30f
space of Retzius 7, 31f
ProTack (Covidien) 67f
Pubic symphysis 40
R
Rectorectal vein of Bendavid 9
Rectus muscle 43f
Repair of hernia 39f
Retropubic vein 9
S
Space of Bogros 8, 30f
Space of Retzius 7, 31f
Spigelian hernia 69
pathophysiology 69
repair 70
Spigelian hernia belt 69
Surgical anatomy of the inguinal
region 1
T
Technique of transfascial ligation
of mesh 72f
Technique of ventral hernia 59
choice of mesh in ventral hernia
repair 61
position 59
principle 61
trocars and ports 59
Total extraperitoneal (TEP)
technique 70
Total extraperitoneal repair 14
anesthesia 15
indications 14
mesh details 14
positions 14
principle 14
technical steps 15
Transabdominal preperitoneal
(TAPP) technique 70
Transabdominal preperitoneal
prosthesis 25
indications 25
mesh details 25
Index
77
principle 25
technical details 25
Transfascial ligation 70
Triangle of doom 12
Triangle of pain 12
U
Uterus 42
V
Ventral hernia mesh plasty 43
X
Xiphoid process 40
Xiphopubic-pubospinal-spinocostal costoxiphoid lines 41
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