Article Number:100922811 (2008) 012059202
A case report of laparoscopic repair of giant incisional hernia in the abdominal wall
ZHOU Xiao-Wu,GU Guo-Li,CAO Hou-Jun,WANG Shi-Lin
(Department of General Surgery, Air Force General Hospital, Beijing 100036, China)
Keywords:Hernia, abdomen; laparoscopy
C.I.C.:R656. 3 Document ID:B
1 Clinical data
The patient, a 69-year-old female, was operated urgently for acute purulent appendicitis with perforation 2 years ago.
She was discharged from the general surgery department of the Air Force General Hospital after enlarged drainage and healing.
1.5 years ago, a swelling protruded from the original incision and grew gradually.
The swelling grew gradually and worsened when standing, but decreased in size when lying down.
On June 8, 2006, he was admitted to our hospital for physical examination: obese body
The right lower abdomen was 8 cm long, and a soccer ball-like bulging mass was seen underneath the right lower abdomen.
The swelling was 20 cm × 18 cm, medium in texture, obvious when standing, and half in size when lying down.
After lying down, the mass was reduced by half, and the abdominal wall defect was obvious. A large incisional hernia was repaired laparoscopically under general anesthesia.
A large incisional hernia repair was performed under general anesthesia. A modified lithotomy position was adopted, and a gastric tube was placed before surgery,
A gastric tube was placed and a urinary catheter was left in place. A 10 mm Trocar was placed through a 1 cm incision at the infraumbilical margin as a 30° laparoscopic viewing hole.
The pneumoperitoneum pressure was maintained at 12 mm Hg,
A 5 mm and 10 mm Trocar were placed on the lateral border of the left rectus abdominis muscle.
One 10 mm Trocar was placed as the main operation hole. Laparoscopic exploration
A large oval-shaped defect was found in the right lower and middle abdominal wall, with the longest diameter of 10 cm,
There were two small intestinal loops and the cecum and its tether at the edge of the defect.
The defect was herniated with extensive dense adhesions. The dense adhesions were separated using ultrasonic knife and electric hook alternately.
The above dense adhesions were separated at least 5 cm beyond the margin of the defect.
A rolled patch for incisional herniation (Bard Composix E) was inserted through the 10 mm Trocar hole.
(Bard Composix E/x Mesh, 15.2 cm × 20.3 cm),
The four corners of the patch were first fixed with silk sutures and then pulled out with a hook and loop needle to the outer abdominal wall for initial removal.
The four corners of the patch were first fixed with silk sutures, and the patch was initially fixed by pulling it out of the abdominal wall with a hook and eye needle. The patch was then fixed with Et hicon Endo2
The patch was then fixed intraperitoneally with an Et hicon Endo2 EMS suture. The patient was discharged 1 week after surgery.
The patient was discharged from the hospital 1 week after surgery. The abdominal wall plasmacytoma appeared 20 d after surgery and was readmitted to the hospital.
After repeated puncture and drainage and compression bandage, the patient was discharged after 1 month.
The patient was discharged after 1 month of healing. The hernia did not recur after 2 years of postoperative follow-up.
2 Discussion
A giant incisional hernia of the abdominal wall is generally defined as a hernia ring with a diameter of more than 10 cm.
Date of receipt:2008201220
or more [1 ]. It is usually seen in obese elderly patients and is caused by incisional infection or incisional dehiscence after abdominal surgery.
It is usually seen in obese elderly patients due to incisional infection or incisional dehiscence after abdominal surgery. The traditional method is to repair the incision after several preoperative pneumoperitoneum preparations and open surgery.
If the preoperative preparation is not adequate, the failure rate of surgery is high, and there are even postoperative cases.
The main reason is the increase of intra-abdominal pressure after surgery and the death of the diaphragm.
The main reason is the increase of intra-abdominal pressure, diaphragm elevation, which affects pulmonary ventilation and ventilation function, and hypoxia leading to
The main reason is the increase of intra-abdominal pressure and diaphragm elevation after surgery, which affects pulmonary ventilation and ventilation function and leads to respiratory failure due to hypoxia. The fundamental indicator to judge the effectiveness of hernia repair is the recurrence rate.
The rate of recurrence is a fundamental indicator of the effectiveness of hernia repair. The recurrence rate can be as high as 35% after open repair with self-material.
The recurrence rate after open repair with self-material can be as high as 35 %, and the recurrence rate after reoperation can be as high as 50 %.
The recurrence rate after open repair with non-tensile patch decreased to 10-24%, and the recurrence rate after reoperation was about 20%.
The postoperative recurrence rate of laparoscopic patch repair was only 2-9%, and the recurrence rate of reoperation was about 20%.
The recurrence rate of laparoscopic patch repair was only 2-9%, and the recurrence rate of reoperation was 9-12%[2] . In China
The success of laparoscopic repair of incisional hernia in the abdominal wall has been reported in China.
There are reports of successful laparoscopic repair of incisional hernia of the abdominal wall, but reports of laparoscopic surgery of large incisional hernia of the abdominal wall
However, reports of laparoscopic surgery for large incisional hernias are rare. We used a Bard composite double-layer patch with an inner layer of expanded polytetrafluoroethylene (e
The inner layer is expanded polytetrafluoroethylene (e2PTFE), which is smooth and does not adhere to the abdominal organs.
The outer layer is a polypropylene layer with a rough surface, which can easily allow the fibrous tissue of the abdominal wall to grow into the patch.
The outer layer of polypropylene has a rough surface, which can easily allow the abdominal wall fibrous tissue to grow in and repair the hernia defect. The Bard composite patch was used for
The use of this Bard composite patch for repair of large incisional hernia in the abdominal wall is in accordance with the tension-free principle of hernia surgical repair and therefore has good results.
The results were good. Compared with open surgery, this case avoids the need for a large abdominal wall incision of at least 20 cm.
The operation avoids the trauma of a large abdominal wall incision of at least 20 cm, the operation is almost bloodless, and the postoperative recovery is rapid.
The advantages of minimally invasive surgery were fully demonstrated with almost no bleeding during the operation and rapid postoperative recovery.
The laparoscopic incisional hernia of the abdominal wall is more difficult and technically demanding.
The technical requirements are high. First, the operating plane of the laparoscope and the abdominal wall are almost at the same water
The operator often needs to operate in a semi-squatting position and needs to repeatedly
The laparoscopic lens needs to be repeatedly turned over for observation. Second, the laparoscopic
The patch must be laid flat in a position consistent with the skin positioning markings outside the abdominal wall and firmly fixed.
The laparoscopic patch must be positioned consistently with the skin positioning markings outside the abdominal wall and be securely fixed. We have learned that the key points for successful repair of a large incisional hernia in the abdominal wall
(1) The tissue around the hernia ring should be separated by at least 5 cm, and the patch should preferably extend 5 cm beyond the edge of the hernia ring.
(2) Initially, the patch should be fixed with 4 stitches of silk.
(2) Initially fix the patch with 4 stitches of silk and then fix it tightly with a hernia suture after smoothing; (3) For obese patients, it is important to fix the patch before and after surgery.
(3) For obese patients, preoperative and postoperative weight loss treatment should be performed.
Air Force General Hospital Journal, Vol. 24, No. 1, 2008, 59 ・
Plasmacytoma formation is one of the most common complications after laparoscopic incisional hernia surgery.
It is one of the most common complications after laparoscopic incisional hernia, especially in huge incisional hernia, because the hernia sac is not removed and it
In particular, in large incisional hernias, because the hernia sac is not removed and there is a gap between it and the composite patch, foreign body reactions in the tissue are more likely to
The hernia sac is not excised and there is a gap between it and the composite patch. It is usually cured by puncture drainage and lap band compression.
However, attention should be paid to the aseptic operation to prevent infection of the patch due to puncture.
References:
[ 1 ] Hernia and Abdominal Wall Surgery Group of the Chinese Medical Association. Abdominal surgical incisional hernia manual
The draft treatment plan for abdominal surgical incisional hernia [J ] . Chinese Journal of General Surgery,2004 ,19 (2) :125.
[ 2 ] Zheng M H, Mao Z H. Laparoscopic repair of incisional hernia of the abdominal wall[J ] . Clinical Surgery Miscellany
Journal of Clinical Surgery,2005 ,13 (2) :1192121.