This video shows Laparoscopic repair of Incisional hernia by Dr R K Mishra at World Laparoscopy Hospital. An incisional hernia result from a hole or defect in the layers of abdominal wall at the site of a previous surgical incision. The incidence of incisional hernia is less common after laparoscopic surgery but it is a fairly common complication after laparotomy.
For more information please contact: World Laparoscopy Hospital Cyber City, DLF Phase II, Gurgaon NCR Delhi, 122002, India Phone & WhatsApp: +919811416838, + 91 9999677788 contact@laparoscopyhospital.com
00:00hello this is a case of laparoscopic repair of the recurrent incisional hernia
00:06this is a 58 year old male has gone laparotomy 6 years ago
00:14and after that one time open incisional hernia repair was performed
00:19and that was not successful it was a recurrent hernia
00:24now we are using the harmonic to do adhesiolysis
00:27it is a minimum adhesion only momentum is adhered
00:39and slowly adhesiolysis is being performed
00:47little pressure has to be given with the left hand from above
00:51so that you can reduce the content
00:55and slowly momentum can be separated
00:59we can see the proline is visible
01:17that proline was for the previous repair of incisional hernia
01:23so
01:25oh
02:00And we can see there are multiple defects, one big defect and two, three, a smaller defect were there. In this case, we will use a simple polypropylene mesh. The dual messes or composite mesh also can be used. But in this patient, we have used a simple 20 by 20 polypropylene mesh.
02:28The vehicle is tightened on all the four corners. And with the help of the suture passer, the suture is getting pulled.
02:42The same screen, a skin prick is there. But during the rectus, some angle has been achieved so that in between the knot, the rectus will hold.
02:55And the first, we will pull the most remote corner of the mesh.
03:01And these are the other corners.
03:15After pulling two lateral corners, we are using some tackers.
03:27Still, the left side of the corners are not being fixed. That we will fix after applying few tackers.
03:45The advantage is that we can manipulate and it can easily spread and there will be completely bilateral symmetrical application of the mesh.
03:56The bigger is the mesh, better is the surgery and it should be approximately protecting four to six centimeters beyond the healthy margin of the defect.
04:13And now the left corners is being pulled one by one corners of the suture is getting pulled.
04:25We have not tied it right now. Just it is held by one artery forcep outside.
04:31And we will tie all the corners at the end of the suture outside in a deflated status of the abdomen.
04:41Because right now the pneumopetoneum is there that is keeping the abdomen stretched.
04:47So just pulling the corners and we are keeping these vitrilles held by one artery forcep.
04:54Now all the corners is pulled.
05:10And then again we will use tacker to fix it.
05:13This is outer crowning.
05:16Distance between the two tacker we are keeping two centimeters.
05:21The lateral umbilical ligament.
05:49This is coming that is inferior epigastic vessel should be taken care of.
05:53That accidentally the protax should not prick the inferior epigastic vessel.
05:57Otherwise there is chance of some bleeding.
06:01Now this outer crowning is complete.
06:03Now we will do the inner crowning.
06:05At the edge of the defect.
06:06Tacker should be not fired.
06:07Now this outer crowning is complete.
06:08Now we will do the inner crowning.
06:09At the edge of the defect.
06:10Tacker should be not fired.
06:11Exactly where the defect is there.
06:12Because at that place the skin is very thin.
06:13And it can prick the skin.
06:14And it can prick the skin.
06:15And it can prick the skin.
06:16And come out.
06:17And that may increase the chance of infection.
06:19strategy of infection.
06:22Right?
06:26Now this outer crowning is complete.
06:28will do the inner crowning at the age of the defect tacker should be not fired exactly
06:36where the defect is there because at that place the skin is very thin and it can prick the skin
06:41and come out and that may increase the chance of infection so this is the inner crowning which is
06:47done now it is over and then the telescope is withdrawn and all the corners will be fixed
07:15you have to tie four to five to six knots and then cut the vehicle is small and automatically once you
07:25will pull the skin the knot will go subcutaneous and then just the new aspirin powder can you can spray
07:33here i'm just pulling the abdominal wall it is disappeared so this way all the corners suture
07:44has been fixed so this was just a very simple case of the incisional hernia
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