This video demonstrate Laparoscopic repair of Incisional Hernia by Two Ports by Dr R K Mishra at World Laparoscopy Hospital. The incidence of incisional hernia repair is increasing each year throughout the world. We created a full laparoscopic herniorrhaphy by means of an easy, reliable, and minimally invasive (two trocars) intraperitoneal onlay technique, using different sizes of a DualMesh. https://www.laparoscopyhospital.com/
For more information please contact: World Laparoscopy Hospital Cyber City, Gurugram, NCR DELHI INDIA 122002 Phone & WhatsApp: +919811416838, + 91 9999677788
00:00hello this is a case of incisional hernia here it is epigastic incisional hernia this
00:16patient was operated for obstruction and he has a biggest card of the midline and just
00:24supra umbilical approximately six and seven centimeter above the umbilical there was incisional
00:30hernia so we are going with the palmer's point and this is the mid-clavicular line just below
00:36the costal margin the skin is stretched up with the left hand with the abdominal valve folded and
00:43eleven number nine so whereas it is perpendicular pointed towards the stomach you will get three
00:56click here external oblique aponidosis internal oblique aponidosis and peritoneum
01:10irrigation suction hanging drop
01:13hanging drop is sucked in
01:27and slow insufflation in the palmer's point is started
01:30means of letter initial reading is english digit and lever durness is obligated
01:47preset pressure 15 actual pressures to slowly slowly increasing then 1.5 two liter gas is in
01:55so car is introduced huge reason we are found but luckily all these additions are momental
02:06so in this patient actually it was taken at person one hour time was spending
02:10in the addition in the addition in the addition itself and we are doing only two ports
02:15because gravity act as a port here you don't need third port so we will not show you the all
02:23additional lysis because it's a time-taking process
02:37so slowly slowly entire additional lysis will be performed
02:42so slowly slowly entire additional lysis will be performed and with the left hand
02:51you can keep on pressing the defect
02:52so that you should be nearer to the abdominal wall
03:06so that you should be nearer to the abdominal wall
03:08so if you have a harmonic additional lysis is very easy
03:29well all the addition will be slowly removed
03:38so
03:44so
03:46so
03:48so
03:50so
03:52so
03:54so
03:58so
04:00Care should be taken that any amount of fat should not be left and the palm of the left
04:14hand should keep on pressing the defect.
04:44This is the ring of the defect.
05:14In ventral herding and when you will keep on using harmonic, automatically the momentum
05:27will drop down and don't need third port.
05:32A little bit falsiform ligament also we have separated because the margin of the mesh should
05:38go beyond at least six centimeters beyond the margin of the defect so a little bit falsiform
05:46ligament is also separated.
05:59So it's over.
06:03Now this is Provisc 3D mesh and it has a polyurethane that is visceral side, blue and smooth and
06:11polyester is a white that will be parietal side.
06:15So this is a 15 by 15 mesh.
06:20You should put the center of the mesh in the center of defect and two centimeter lateral
06:25to all the four corners, one millimeter stab wound will be given on the skin only.
06:32This is just to pass the suture posture.
06:44Mesh is rolled.
06:46The valve is opened and with a grasper you can lock the grasper and directly the mesh is introduced
06:52keeping the cannula towards the anterior valve and slowly you can push it into the abdomen.
07:01The mesh is tied at two places and with the harmonic you can cut the vicryl which was used
07:06to keep the mesh rolled and you can remove the vicryl.
07:13Now the transparietal fixation will be performed and here we are using the suture posture to pull
07:26all the four corners of the mesh.
07:29The skin incision will be same, rectus incision will be different.
07:38Pricking the rectus two centimeter away from the first prick but skin will be same prick and
07:45all the four corners will be first fixed.
07:49The advantage of fixing the corners that you have symmetrical placement of the mesh it should
07:55be all around six centimeter beyond the margin of the defect.
08:02The mapping is already done from above so there is no chance the mesh will be asymmetrical.
08:10You will have the nice symmetrical placement of the mesh.
08:24So this is the third corner so it is fixed.
08:39And the most near corner near the cannula will be fixed at the end.
08:51Now all the corner is fixed and now with the protag this is outer crowning to two centimeter
08:59distance you can do outer crowning of the mesh.
09:05It should be perpendicular to the abdominal wall so left hand will keep on giving the counter
09:11so that nicely you can fix the mesh without corrugation it should be straight flat and parietal
09:18side should be completely touching the abdominal wall.
09:30Start pulling from center and go to the periphery.
09:34Just like how you are spreading the bed seat so that it should be nicely touching the parietal
09:40wall.
09:41At this time the pressures can be a little bit decreased so that in spite of removing the
09:46gas mesh should remain flat.
09:59Now it has started inner crowning and all around the rectus defect you can fix the mesh.
10:06Left hand is supporting from above so that at the time of firing your tip of the autoswitcher tacker should be perpendicular to the abdominal wall.
10:13You can fire all around.
10:14Inner crowning is done.
10:15Inner crowning is done.
10:16Inner crowning is done.
10:20It's almost over.
10:21So laparoscopic repair.
10:27The tip of the autosuture tacker should be perpendicular to the abdominal wall.
10:33You can fire all around. Inner crowning is done.
10:42It's almost over.
10:46So, laparoscopic repair of incisional hernia is an easy procedure.
10:51If there is no much rectus divertication, you don't treat much suture.
10:55Thank you very much for watching this video. Have a nice day.
