PROCEDURE: Right lower quadrant exploration with removal of old mesh and closure with new biologic mesh.
INDICATIONS FOR PROCEDURE: The patient is a 56-year-old female who has had previous hernia repair and had a laparoscopic right abdominal hernia repair with mesh in 06/2013. She continues to have a knot in that right lower quadrant that is painful. CT did not show a hernia. She now is to undergo exploration with removal of probably that portion of mesh and probable biologic mesh placement.
DESCRIPTION OF PROCEDURE: In the supine position, the abdomen was prepped and draped in the usual fashion. After anesthetizing with 0.25% Marcaine, the old incision was opened and deep tissues were exposed down to that of the abdominal wall. You could feel this mesh through this. I opened the external oblique, internal oblique and then was able to get in to where this mesh was. There was intense reaction around that, about a 2 cm area. I then freed up this mesh and then removed essentially the majority of that mesh and it did not look infected. After ensuring I removed that completely, I felt I should put a biologic mesh deep and close over top of this. I therefore took the smallest XenMatrix mesh, which was 10 x 15 cm. I then placed a circumferential #1 PDS plus, suturing it to the mesh and to the abdominal wall. It was then rested appropriately and tied down. The muscle was then reapproximated with running #1 PDS incorporating the mesh medially. After ensuring that looked good, deep tissues were closed with running 2-0 Vicryl. Skin edges closed with running 4-0 Monocryl subcuticular stitch. Steri-Strips and a sterile dressing was applied.
ESTIMATED BLOOD LOSS: Minimal.
Sponge and needle counts were correct. She tolerated the procedure and was taken to the recovery room in satisfactory condition.
Any takers????
Thanks
INDICATIONS FOR PROCEDURE: The patient is a 56-year-old female who has had previous hernia repair and had a laparoscopic right abdominal hernia repair with mesh in 06/2013. She continues to have a knot in that right lower quadrant that is painful. CT did not show a hernia. She now is to undergo exploration with removal of probably that portion of mesh and probable biologic mesh placement.
DESCRIPTION OF PROCEDURE: In the supine position, the abdomen was prepped and draped in the usual fashion. After anesthetizing with 0.25% Marcaine, the old incision was opened and deep tissues were exposed down to that of the abdominal wall. You could feel this mesh through this. I opened the external oblique, internal oblique and then was able to get in to where this mesh was. There was intense reaction around that, about a 2 cm area. I then freed up this mesh and then removed essentially the majority of that mesh and it did not look infected. After ensuring I removed that completely, I felt I should put a biologic mesh deep and close over top of this. I therefore took the smallest XenMatrix mesh, which was 10 x 15 cm. I then placed a circumferential #1 PDS plus, suturing it to the mesh and to the abdominal wall. It was then rested appropriately and tied down. The muscle was then reapproximated with running #1 PDS incorporating the mesh medially. After ensuring that looked good, deep tissues were closed with running 2-0 Vicryl. Skin edges closed with running 4-0 Monocryl subcuticular stitch. Steri-Strips and a sterile dressing was applied.
ESTIMATED BLOOD LOSS: Minimal.
Sponge and needle counts were correct. She tolerated the procedure and was taken to the recovery room in satisfactory condition.
Any takers????
Thanks
abd wound exploration
