By Michael J. Rosen MD FACS
Atlas of stomach Wall Reconstruction, edited through Michael J. Rosen, bargains accomplished insurance at the complete diversity of belly wall reconstruction and hernia fix. grasp laparoscopic maintenance, open flank surgical procedure, mesh offerings for surgical fix, and extra with fine quality, full-color anatomic illustrations and medical intra-operative pictures and movies of approaches played via masters. In print and on-line at www.expertconsult.com, this targeted atlas offers the transparent assistance you must take advantage of powerful use of either regularly played and new and rising surgical options for stomach wall reconstruction.
- Tap into the adventure of masters from video clips demonstrating key moments and methods in belly wall surgery.
- Manage the entire variety of remedies for belly wall issues with assurance of congenital in addition to got problems.
- Get a transparent photograph of inner buildings due to top quality, full-color anatomic illustrations and scientific intra-operative photographs.
- Make optimum offerings of surgical meshes with the simplest present info at the variety of fabrics to be had for surgical repair.
- Access the totally searchable contents and movies on-line at www.expertconsult.com.
Master typically played in addition to new and rising surgical options for stomach wall reconstruction
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This protects the biomaterial from the patient’s skin flora. 2. Gaining Abdominal Access s bdominal entry can be the most difficult step in the patient who has undergone multiple A abdominal operations. Selecting the location for entry can be challenging because many of these patients have had numerous abdominal incisions. The upper quadrant at the tip of the eleventh rib is generally a safe place to gain access even in such cases. The side of entry should avoid previous incisions. For example, in the patient with an open cholecystectomy incision, the left upper quadrant should be chosen.
Large defects require more frequent sutures; smaller, “Swiss cheese”–type defects may need fewer. s Before completion of the case, one last inspection of the abdominal cavity is performed to rule out continued bleeding. The fascia at trocars larger than 5 mm should be closed with suture in this hernia-prone population. The skin at the trocar sites is closed with subcuticular stitches, followed by skin tapes or tissue cyanoacrylate. s An abdominal binder may be placed for patient comfort. The role of binders in seroma reduction is unclear.
Cooper’s ligament is identified bilaterally, and the bladder is mobilized inferiorly into the space of Retzius. If the hernia abuts the pubis, it is important to mobilize the bladder sufficiently to allow several centimeters of mesh to be tucked under the pubis (Fig. 3-8). Chapter 3 • Laparoscopic Repair of Atypical Hernias: Suprapubic, Subxiphoid, and Lumbar 51 Space of Retzius Location of inferior epigastric vessels (lt) Suprapubic hernia defect Location of Cooper’s ligaments Location of inferior epigastric vessels (rt) Bladder A B Bladder flap Medial umbilical fold Figure 3-8.