By Michael J. Rosen MD FACS
Atlas of belly Wall Reconstruction, edited by means of Michael J. Rosen, deals finished insurance at the complete diversity of stomach wall reconstruction and hernia fix. grasp laparoscopic upkeep, open flank surgical procedure, mesh offerings for surgical fix, and extra with fine quality, full-color anatomic illustrations and medical intra-operative photos and video clips of strategies played by means of masters. In print and on-line at www.expertconsult.com, this unique atlas presents the transparent suggestions you must take advantage of potent use of either mostly played and new and rising surgical suggestions for stomach wall reconstruction.
- Tap into the event of masters from movies demonstrating key moments and methods in stomach wall surgery.
- Manage the total diversity of remedies for stomach wall issues with assurance of congenital in addition to bought problems.
- Get a transparent photo of inner buildings because of high quality, full-color anatomic illustrations and scientific intra-operative photographs.
- Make optimum offerings of surgical meshes with the easiest present details at the diversity of fabrics on hand for surgical repair.
- Access the totally searchable contents and video clips on-line at www.expertconsult.com.
Master normally played in addition to new and rising surgical strategies for belly wall reconstruction
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2-3). 3. Adhesiolysis s he Achilles’ heel of the laparoscopic ventral hernia repair is the lysis of adhesions. This T step can be the most time consuming and usually determines the length and complexity of the case. s A 30-degree laparoscope is mandatory to adequately visualize the anterior abdominal wall. A 5-mm laparoscope provides more flexibility in moving the camera; however, if the visual clarity is poor, a 10-mm scope should be used. s Energy sources should be avoided during adhesiolysis.
Scheduled intravenous ketorolac is a useful adjunct. s The postoperative diet depends on the degree of adhesiolysis. Following procedures where there is a lengthy lysis of adhesions or when bowel is densely involved, the patient is kept NPO. The diet may be advanced when abdominal distention has resolved, and the patient is without nausea. s Hospitalization in the immediate postoperative period also allows the surgeon to monitor for any signs of missed enterotomy. There should always be an index of suspicion, particularly in difficult cases.
Blunt dissection with gentle, short sweeps is very effective in this situation. Chapter 2 • Laparoscopic Ventral Hernia Repair—Standard 27 Tip of 11th rib 10/12 mm 5 mm 5 mm 5 mm (optional) 5 mm ASIS LOCATION OF TROCARS Figure 2-3. SHARP ADHESIOLYSIS Figure 2-4. 28 Section II • Laparoscopic Repairs s xternal pressure applied on the abdominal wall by the assistant provides help during E adhesiolysis. This move can be critical in the morbidly obese patient or in the situation where adhesions are up in the hernia sac.