1 / 40

بسم الله الرحمن الرحيم

بسم الله الرحمن الرحيم. IN THE NAME OF ALLAH THE MOST GRACEFUL THE MOST MERCIFUL. LAPAROSCOPIC. HERNIA REPAIR. INSTRUMENTS REQUIRED. Laparoscope 30 0 Three – four Trocars (10-12 m.m.) + reducers Dissector Grasper Diathermy needle Suction tube Endo-hernia Endo-Clip clips

dennis-leach
Download Presentation

بسم الله الرحمن الرحيم

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. بسم الله الرحمن الرحيم IN THE NAME OF ALLAH THE MOST GRACEFUL THE MOST MERCIFUL

  2. LAPAROSCOPIC HERNIA REPAIR

  3. INSTRUMENTS REQUIRED • Laparoscope 300 • Three – four Trocars (10-12 m.m.) + reducers • Dissector • Grasper • Diathermy needle • Suction tube • Endo-hernia • Endo-Clip clips • Marlex, polypropylene mesh or surgipro (different sizes) • Laparoscopic needles and needle holders

  4. ANATOMY FROM INSIDE

  5. Trans-peritoneal Laparoscopic View

  6. Pre-peritonealSCHEMATIC VIEWS

  7. Pre-peritoneal Real View

  8. TROCARS SITING

  9. Types of Laparoscopic Repair • On-Lay mesh patch • Transperitoneal: a) pre-peritoneal mesh b) plug and mesh c) Cigarettes and mesh • Extra-peritoneal approach

  10. ON-LAY MESH PATCH • Intra – peritoneal • Weight of viscera to fix it • Complications (adhesions, obstruction and fistulas) • Less testicular pain and swelling • Not recommended by many authors

  11. Trans-peritoneal(Pre-peritoneal)Mesh only mesh and plug mesh and cigarettes

  12. MESH ONLY

  13. MESH AND PLUG

  14. MESH AND CIGARRETTES (Video – presentation)

  15. Extra-Peritoneal Approach (Video presentation)

  16. Advantages of Laparoscopic Hernia Repair • Anatomy is clear. • Suitable for bilateral and recurrent hernias. • Quick convalescence (resume working after 1-7 days). • Less pain and scrotal swelling post-operatively. • Inguinal canal is not opened (less risk of nerves and cord injuries)

  17. Disadvantages • A little more expensive than anterior approach. • Higher recurrence rate (initial studies) than anterior approach Viz: Bassini’s, McVay or Litchenstien’s repair. • Requires G.A. • Takes a little longer operating time ( 2 – 2 ½ hours) • Needs experts.

  18. Training requirements for Laparoscopic Hernia repair • Attending basic courses in Laparoscopic surgery. • Training course in Hernia repair. • Surgeon should be familiar with the instruments. • Should know how to operate with both hands. • Learn how to suture laparoscopically. • Learning the anatomy of the region (very important). • Observing experts, assisting them and operates later on.

  19. INDICATIONS • Bilateral Hernias (avoid long recoveries because of incisions) • Recurrent Hernias (avoid dissecting scarred tissues, so less chance of cord and nerve injuries).

  20. CONTRA-INDICATIONS • Patients who can not tolerate G.A. • Large incarcerated sliding hernia

  21. POTENTIAL COMPLICATIONS OF Laparoscopic hernia repair • Complications related to the laparoscope: a) Gas embolism b) Trocar injury (Bl. Vessels, bladder, bowel) c) Cautery injury (bladder, bowel)

  22. 2. Complications related to the repair:a) Vascular injuryb) Bladder / bowel injury c) Injury to vas deferensd) nerve injurye) migration or infection of prosthesisf) adhesions and bowel obstructiong) Seroma formationh) Recurrence

  23. PERSONAL EXPERIENCE59 Cases Al-Salama Hospital, Jeddah October,1991 – JUNE,1998

  24. Total no. 59 cases( OCT. 1991- JUNE 1998 )ANALYSED 47 CASES( OCT. 1991- FEB. 1996 )Unilateral Bilateral Pantalloon(38) (6) (3)

  25. Sides Indirect 17 (one recurrent)Rt Direct 1Patalloon 2Indirect 16 (onesliding sigmoid) Lt. Direct 4Patalloon 1 Bilateral 6

  26. Males 45SEXFemales 2(unilateral left side indirect)

  27. AGE18 - 78 years(mean 37years)

  28. Types of operation Mesh patch only 7 • Pre-peritoneal Mesh and cig. 18 (2-7 cig) Mesh and plugs 6 • Extraperitoneal 16

  29. Marlex 24Material usedSurgipro 7polypropylene 16

  30. Anaesthesia timeUnilateral(1.30 – 4 hrs) fatty patient,big defectBilateral (3 – 3.15 hrs)

  31. Post-op follow-up Pain : Patient given I.M Voltaren and Nubain 4-6 hourly for 24 hours. All received prophylactic antibiotics for 3 doses post-op. All discharged with pain killers to be taken PRN. Same day of op 4 Ambulation1st post-op day 40 2nd post –op day 3

  32. Hospital stay: (1-7 days) average 2 days ( 7 days for that with D.V.T.) • Return to work: 3 days to 5 weeks (D.V.T.) ( Average 7 days) • Lifting heavy objects : 6 weeks

  33. Complications • During Surgery: One case, injury to U.B. stitched with Vicryl + catheter for 10 days

  34. Continuation: Complications II. Post-op: - Retension of urine: One case responded to urinary catheterization for 24 hrs. - Neuralgia of upper medial part of thigh (staples) - Seroma – one case detected by U/S and aspirated from inguinal region. - Recurrence (4.2%) = 2 one after 3 months + one after 15 months post-op. - Trocar Hernia - One at umbilical port repaired later on

  35. Continuation: Complications II. Post-Op • Bleeding • Infection • Hydrocele • Orchitis NONE • Pelvic collection • Bowel injury

  36. Length of follow-up OCT. 1991 – JUNE 1998 ( 6 YEARS + 8 MONTHS ) ( 80 MONTHS )

  37. THANKYOU

More Related