Wednesday, July 27, 2005

Tales from the Operating Room VII....
It has been awhile since I had pictures to post. 60-ish year old about 15 months out from a right hemicolectomy for a large polyp. Presented to me with about 2-3 months of abdominal "bulging". Exam revealed a hernia with approximately 6cm defect and a questionable defect superior to that one. To the OR:

The circle is the superiormost defect. It was the "questionable" one felt on physical exam.

Working our way down, you can see the defect encircled above at the left.

Some more.

Five defects here. Defect number 1 was the palpable one that caused the patient to see me.

There were about 9 defects in all. The advantages of laparoscopic hernia repair can be summed up in these photos. Many of the smaller could have easily escaped detection during an anterior repair. Likely they would have increased in size and the patient would have presented with a "recurrence". This required a 32x18 cm sheet of Gore DualMesh to repair. Eight anchoring sutures were placed after numbering them and the mesh was placed into the abdomen. They sutures were brought through the abdominal wall with a Gore Suture Passer and tied. The mesh was then tacked to the anterior abdominal wall.
Here are the "after" pictures:

Technology can be wonderful.
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