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首页> 外文期刊>Surgical Endoscopy >A novel approach to extraction of incarcerated omentum and mesh insertion in laparoscopic ventral hernia repair.
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A novel approach to extraction of incarcerated omentum and mesh insertion in laparoscopic ventral hernia repair.

机译：腹腔镜腹疝修补术中嵌顿大网膜和网孔插入的新方法。

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During laparoscopic ventral hernia repair (LVHR), it is not always possible to reduce incarcerated omentum through a tight defect and it may tear or require transection within the abdomen. This leaves an ischemic mass of tissue within the hernia sac which can cause pain, infection, or the appearance of hernia recurrence postoperatively. We describe a technique which allows extraction of any retained omentum within the hernia sac, mesh insertion, and laparoscopic completion of the procedure using only 5 mm trocars.After obtaining access to the abdomen with a 5 mm optical trocar in select patients, lysis of adhesions is performed as needed. When incarcerated omentum that cannot be safely reduced is discovered, it is transected at the level of the abdominal wall using electrocoagulation or ultrasonic dissection. At this point, we make a 2-3 cm skin incision overlying the retained omentum, open the hernia sac, and remove the amputated omentum. The rolled up piece of mesh utilized for the repair is then inserted through this opening. The hernia sac is closed with absorbable suture, allowing reinsufflation of the abdomen and completion of the laparoscopic repair.This method enables us to safely remove any retained omentum from the hernia sac and utilize the same incision for mesh insertion. We utilize only 5 mm trocars without the need for a larger port through which to place the mesh into the abdomen. This reduces the risk of postoperative trocar site hernias as the opening for mesh insertion is covered by the mesh after it is fixed in place. This technique may also decrease the need for conversion to open hernia repair by allowing an alternative approach to reduce incarcerated omentum.
机译：在腹腔镜腹疝修补术（LVHR）期间，并非总是可能通过紧密的缺损减少嵌顿的网膜，并且它可能会撕裂或需要在腹部内横切。这在疝囊内留下了局部缺血的组织，可能导致术后疼痛，感染或疝气复发。我们描述了一种技术，该技术允许仅使用5 mm套管针提取疝囊内任何残留的大网膜，插入网孔并进行腹腔镜手术。在选定的患者中使用5 mm光学套管针进入腹部后，粘连溶解根据需要执行。当发现无法安全减少的嵌顿大网膜时，可使用电凝或超声解剖在腹壁处横切。此时，我们在保留的网膜上做一个2-3厘米的皮肤切口，打开疝囊，并除去截肢的网膜。然后将用于维修的卷起的网片插入穿过该开口。疝囊用可吸收的缝合线封闭，允许重新吹入腹部并完成腹腔镜修复。这种方法使我们能够安全地从疝囊中去除任何残留的网膜，并利用相同的切口进行网孔插入。我们仅使用5毫米的套管针，而无需使用较大的端口将网孔放入腹部。这减少了术后套管针疝气的风险，因为在将网格固定到位后，网格覆盖了用于网格插入的开口。该技术还可以通过允许减少嵌顿大网膜的替代方法来减少转换为开放性疝修补术的需要。

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