Laparoscopic Repair of Para Umbilical Hernia by Dr R K Mishra

Aaradhya Sharma

https://www.laparoscopyhospital.com/SERV01.HTM  This video demonstrate Laparoscopic Repair of Para Umbilical Hernia performed by Dr. R.K. Mishra at World Laparoscopy Hospital. Ventral hernia results from a weakness in the musculoaponeurotic layer of the anterior abdominal wall. Many this type of hernia has root of development during the period of development like; omphalocele, gstroschisis and congenital umbilical hernia.  For more information please contact:  World Laparoscopy Hospital  Cyber City, DLF Phase II, Gurgaon  NCR Delhi, 122002, India   Phone & WhatsApp: +919811416838, + 91 9999677788 contact@laparoscopyhospital.com

Transcript

00:00Good morning. This is a case of laparoscopic repair of paraumblycal hernia. This patient

00:12was having approximately 4 cm size of the hernia outside and the omentum was incarcerated

00:20also. We can see here the trance illumination, the telescope and the light is coming through

00:26the hernia. We have entered through the palmer's point and just one sponge was pushing the hernia

00:34to retract just to like reduce all the content and the content was omentum only there was no

00:41bowel at all and with the harmonic we are just dissecting some of the omentum on the periphery

00:48so that the hernia can be reduced and it is very easy in those cases where the bowel is

00:56not there and now slowly with the pressure applied from outside the entire content of the hernia can

01:03be reduced and here slowly it is coming out and then all the omentum which was inside the sac is

01:13taken in the abdominal cavity. Now here this is the hernia sac easily is visible you can sometime

01:21introduce the telescope also inside to inspect it and here this telescope is entering into the sac there

01:29is little fat at the level of the neck and here this is the only skin there in the cases of the ventral hernia

01:37skin becomes very little thin and generally only mesh repair we are preferring here in this case we are

01:44using the simple polypropylene mesh although we have the different choices like you can use vibro mesh you

01:51can use go text mesh proceed mesh is also there and polyurethane mesh is also available but this

01:59patient was a little poor and we he was not able to afford the expensive mesh and we have a good

02:06experience of using the polypropylene also if you use polypropylene also there is no much adhesion especially

02:14if you will spread the momentum nicely and if you will mobilize the patient earlier chances of the

02:20bowel adhesion can be minimized now we have tightened the vicryl at all the four corners and with the help

02:28of the suture posture now at the corners the vicryl has been pulled out the skin prick is same and the

02:35rectus prick is different so that when you will tie the knot it will go subcutaneously previously we were

02:42using the proline but now we use number one vital because it is also equally good and it doesn't have

02:48the chances of the pain in the proline sometime percent has the pain because of the proline pricks

02:54the skin always so vital and together within the internal crowning we are using the tracker also

03:01so this is the third corner which is pulled and now exactly same way the fourth corner also will be

03:07tightened so after fixing all the corner of the mess now you will use tacker and the distance between

03:14first and second firing of the tacker should be minimum two centimeter and external and internal

03:21two crowning outer crowning and inner crowning of the tracker will be performed here we are using the pro

03:25tack that is from the auto suture and then you can just apply it all around so this way the laparoscopic

03:33repair of the ventral hernia is a relatively very easy procedure and it can be performed very easily

03:39even by the beginners and in cases of a small hernia tension free repair and only repair is also equally

03:46good and if you will see the adhesion the chances of adhesion is much less compared to inlay in inlay the

03:54tissue trauma is much more in only if you will just take care that momentum should be spread out

04:00and if the patient is early mobilized then we don't have much cases of the fistulization or obstruction

04:07so thank you very much for watching this video and i hope you like it thank you

04:30you

05:00You

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