This video demonstrate laparoscopic IPOM Mesh Repair of Ventral Hernia performed by Dr R K Mishra at World Laparoscopy Hospital. Laparoscopic ventral hernia repair is a technique to fix tears or openings in the abdominal wall using small incisions, laparoscopes (small telescopes inserted into the abdomen) and a patch (screen or mesh) to reinforce the abdominal wall. It may offer a quicker return to work and normal activities with decreased pain for some patients.
00:00Hello, this is a case of Pada Ambilical Hernia. Here is the Palmer's point and that is the mid
00:19clavicular line just below the costal margin and for any ventral hernia Palmer's point is
00:25the preferred choice you have to give one a small stab wound and after that you can
00:32introduce the various needle pointing towards the stomach perpendicular to the abdominal wall
00:48now you can perform the irrigation suction and hanging drop test to make it sure that
00:55you are preperitoneal you are in the peritoneum and it is sucked in then you can start insufflation
01:06nasogastric tube is must so that abdomen stomach should be deflated pressure pressure 15 set flow rate
01:22one liter per minute and as soon as 200 ml of gas has gone in lived unless here also will be obligated
01:29and the graph of the actual pressure and total amount of gas usage should go parallel initially
01:37first few hundred ml the actual pressure should be single digit it should be 0 1 and it is same as
01:46anywhere else so now after one liter you can increase the flow rate to 3 but the maximum flow rate to the eye of the
01:57various needle is 2.5 liter per minute we can see now that slowly the pressure is increasing and the pneumo
02:07is forming so palmer point is the safest area wherever umbilicus cannot be used as access for the primary trocar and for the various little both
02:20minimum amount of gas required is 1.5 liter and maximum 6 liter and slowly the actual pressure is increasing
02:32Then the problem rack is increasing
02:34then the trace is increasing
03:00Hernia sac will distend, it will pop out
03:03Once the pneumopatronium will be created
03:06You can see the bulge of the hernia here
03:08It was a large hernia
03:10And now we are putting the
03:14It is a distance and it is homogenous
03:17It is complete
03:19You can, once the trocar is introduced
03:28That should be also pointed towards the stomach
03:32Here we can see the hernia, two defects are there
03:38And momentum is at here
03:53So from above with the finger
03:55You should push the sac down
03:59And you can separate the momentum
04:02Taking care that the skin should not get burnt
04:08And there should not be any redundant fat
04:12Left inside the defect
04:15This is only two port
04:37One port is umbilicus
04:39One port 10 cm below
04:415 mm
04:42We perform almost all the ventral hernia by two ports
04:46Because gravity will help you
04:47Now you have to deflate the abdomen
04:50And put a
04:50Here 15 by 20 size of the mesh
04:53Put a mesh over the defect
04:56Keeping in mind that center of the mesh
04:58Should be in the center of the defect
04:59And 2 cm lateral to the each corner
05:03One 2-2 mm stab wound will be given
05:07That is for trans-facial
05:10Fixation of the mesh
05:14And now with the palmer's point
05:16You can introduce the mesh inside
05:18Open the valve
05:22And directly with the cannula
05:24Mesh can easily introduce
05:25You can apply little gylocin also if you want
05:28That will facilitate the easy entry
05:30After that most remote
05:33Corner should be fixed first
05:35Here we are using the suture parser
05:37That is facial closure needle
05:40And all the corner will
05:42Trans-facial fixation will be done
05:44You have to pull each
05:49End of the suture
05:51Separately each time
05:53Skin opening should be same
06:00Rectus, peritoneum and muscle
06:02Should trap the suture in between
06:05So that it will hang over
06:06And it will hold the mesh
06:10Mapping of the mesh
06:16With the deflated abdomen
06:17And keeping the preak
06:202 cm lateral will make it sure
06:22That mesh is nicely
06:25All around is
06:26Nicely stretched
06:29And it will be
06:32Bilaterally symmetrically placed
06:34So all the corner
06:43Trans-facial fixation is done
06:45This is a polyurethane mesh
06:48In this mesh
06:49The blue color is polyurethane
06:53Which should be towards the bowel
06:55And white color is polyester
06:58That will be towards the abdomen wall
07:00This mesh is made for the
07:03Intrapatronial application
07:05And now this is outer crowning
07:07With the tacker
07:08You can fix
07:09To 2 cm all around
07:12The outer crowning
07:14With the left hand
07:16It has to be supported
07:17And the tacker tip
07:21Should be perpendicular
07:22To the abdominal wall
07:231 cm of the falls
07:30And the tail
07:31By the prz Michaela
07:31That janties
07:32What punishment
07:32In this detail
07:32The fashionable
07:33It has to light
07:33So the lateral
07:34And stable
07:35darle
07:35And the red
07:36Now this will be
07:36For the eleven
07:36They are
07:37So the WordPress
07:37And the load
07:38And now this will be
07:39má»™t
07:40I got too old
07:40And
07:41Enough
07:41Ventral hernia surgery is an easy surgery, especially you don't have to dissect the
08:00sac and intraperitoneal only mess repair is now a standard technique with the mess which
08:10is dual mess you can use it and adhesion is rare little mental adhesion may be may be expected
08:19but most of the time if you mobilize the person earlier it won't happen so all the corner has
08:28been fixed now as you can see the message nicely spread all around care should be taken that it
08:35should be spreaded and there should not be much corrugation if you will spread the attacker from
08:47the center to the periphery it will stretch it nicely now this is inner crowning inner crowning you
08:59have to do around the periphery of the defect over the rectus ring but take care that it should not
09:06be fired where that effect is actually present
09:13there is a falsiform ligament is coming little in the way but there is no problem once you will fix it it will get hanged otherwise you will fix it will get hanged
09:20my
09:35the falsiform ligament is coming little in the way but there's no problem once you will fix it it will get hanged otherwise you may cut the falsiform ligament also
09:46so it's almost nicely spread all around and it will cover it after that you have to deflate
09:59the abdomen this bulge will go right now and at the end you have to give support abdominal
10:05support to this bulge with the elastic which is gone now there was a gas that's why it was
10:10extended and then these trans facial suture at the end after deflating the abdomen should be tired
10:18four five knots has to be tired and once you will pull the skin it will go percutaneous
10:40and here you do like that and it has gone in so all the corner has to be fixed
10:58previously people were using the proline but now we don't use proline we use ethibond
11:11or goretax suture if you buy polyurethane mesh it has already the suture on the corners the company
11:21they themselves they tie the suture on the corners and just you have to use it you don't need to tie
11:25yourself if you are using vipro or other mesh you may need to do so
11:38and pull the skin it has gone in
11:46so even though if you are using tacker using trans facial fixation has many advantage one
11:52advantage that you are sure that the center of the defect is in the center of the mesh you are also
11:58sure that it is stretched nicely and you are sure that it is bilateral symmetrical because inside we
12:04don't have a depth perception so if you use it properly it will it will have a good application
12:10so this is the standard technique of performing the laparoscopic hernia ventral hernia thank you very much
