[1712560]
During complex hernia repair, we elected to use a single piece of mesh, given that the intact fascia between the 2 defects was very small and attenuated in appearance. Careful intra-abdominal measurements were made with a measuring tape to determine that the left sided hernia was 3x4cm and the right sided hernia was 5x5cm with a left sided/midline attenuation of an add'l 3x3cm. Together we determined that a 20x22cm piece of polyester mesh would provide 5cm overlap in all directions. We then used the enseal to strip the urachal remnant and midline fat in the lower abdominal wall along with the associated peritoneum to expose the fascia. We exposed the under surface of the symphysis pubis to the dome of the bladder. We then cut a piece of parietex to size -20x22- and introduced it into the abdomen after the port to the left of the umbilicus was up-sized to a 12mm port. We initially secured the mesh to the anterior abdominal wall using two 2-0 gore-tex sutures. These sutures were passed through the abdominal wall with a gore-tex suture passer. Once the mesh was positioned such that there were 5cm margins on each side of the defect, an absorbatack laparoscopic suture packer was used to place the mesh onto the anterior abdominal wall. Of note, when we went to remove the measuring tape, it had become softened and ripped, leaving a portion sandwiched between the mesh and the anterior abdominal wall just above the pubis. After considering the risks of opening to retrieve this paper tape, it was considered safer to leave it in place. It was decided to leave the tape where it was and disclosed this to the pt and family. Dates of use: (b)(6) 2011.
Patient Sequence No: 1, Text Type: D, B5