68

Surgicot Procedures lncluding Minimol Access Procedures

Abdominol Extrointestinol Surgery o

$p

Epigastric. Begin at the incision extending from the clavicles to the upper thighs, and down to the table at
the sides.
prepare widely enough to allow for extension of the incision.

[ffne*cn
il,r+nrwopic groin herniorrhaphy is among the most

Incisional. Begin at the site of previous incision;

lh h

m''uroversial laparoscopic procedures being performed. present techniques of traditional hernia repair are n@en techniques, performed without violation of the

.T"Irninal cavity, often under local anesthesia. The

dlages

Droping
Folded towels and a fenestrated sheet

adof a laparoscopic hernia repair are purported to narked reduction of pain and rapid return to normal lctiTit-v. The disadvantages are the requirement for genual anesthesia and a lack of long-term follow-up data.

Equipment Electrosurgical unit lnstrumentotion

Basic/lVlinor procedures tray

fudure
H[owing the establishment of a pneumoperitoneum, a trlttD to 11 mm iaparoscope is inserted through the umHfifal port. The patient is placed in the Trendelenburg trmsition, and the abdomen is inspected. A second and

Self-retaining retractor
Supplies

(e.

g., Adson, optional)

Basin set
Blades (2) No. 10, (1) No. 15 Needle magnet or counter Penrose drain (small, for retraction, optional) Dissectors (e.g., peanut)

&ird 10 to 11 mm port are created lateral to the rectus death at the level of the umbilicus on the side of the tref,t. Both inguinal rings are examined for hernias. the hernia sac, if present, is retracted out of the inpinal canal, and a segment is excised. Peritoneal flaps re developed by blunt dissection. Care is taken to

mid injury to the spermatic vessels and vas deferens n tle male A piece of mesh (e.g., Marlex, Gortex, or
Srmeipro) is fashioned to cover the hernial defect and a wrounding rim of the abdominal wall. (Slit[s] may be

Electrosurgical pencil Skin closure strips (optional)

nade in the mesh for the epigastric vessels and the

SpeciolNotes
The small Penrose drain (used to isolate the spermatic cord) is moistened in saline and passed on a Pean clamp. Synthetic mesh such as Mersilene or Marlex is often used to repair recurrent hernias or large ventral defects.

LAPAROSCOPIC GROIN HERNIORRHAPHY

Definiiion
Repair of an inguinofemoral musculofascial defect employing laparoscopic technique.

ryermatic cord. Some surgeons staple a piece of mesh into the surrounding rim of the abdominal wall as a reinfor'cement.) The mesh is then inserted via a port and Aplaced over the hernia defect. Endoscopic staples are pnrployed to staple the mesh to the abdominal wall. Care is again taken to avoid injury to the spermatic ressels, vas deferens, and epigastric and iliac vessels as indicated. The pneumoperitoneum is relaxed. The peritonial flaps are then stapled together to cover the mesh and as an attempt to prevent adhesions to the bowel. C;ontralateral repair has been advocated by some authorities deSpite absence of a frank hernia. Some surgons may repair indirect, direct, and recurrent lapamscopic inguinal hernias by preperitoneal approach.