A 67 yrs old lady who underwent LAR for Rectal Ca 10 days ago came back because "guts came out of the place where the rubber tape was before". Upon examination this very unusual finding was seen.
A. Transillumination and finger depression of the abdominal wall confirm juxtaposition of the inflated stomach and the anterior abdominal wall. B. The site selected will generally be approximately halfway between costal margin and umbilicus.
Method of mesh fixation with a suture passer. Use the suture passer to introduce the suture through the musculofascial layer, the mesh, and then back out through all layers as a mattress suture. Use four to eight mattress sutures to anchor the mesh, depen
Sagittal view of extraperitoneal dissection. A space is developed between peritoneum and abdominal wall. Note that the bladder is mobilized downward.
Surgeon using nondominant (left) hand to palpate the head of the stapler/tacking device through the anterior abdominal wall, thus verifying stapler/tacking device position relative to external landmarks and providing counterpressure.
Stay sutures have been placed and tied. Two enterotomies have been made and the stapler is inserted into the two enterotomies. The bowel and gallbladder must be carefully positioned to fully utilize the entire length of the stapling device (by pulling the
The abdominal wall upon completion of the procedure. The external and anchoring sutures are secured to the skin.
Passing one of the dilators through the abdominal wall and into the lumen of the jejunum. Care is taken to pass the dilator just into the lumen of the bowel (under visual laparoscopic control), not far enough to risk posterior intestinal wall perforation.
The anchoring sutures are being placed. The suture is passed through the abdominal wall, a seromuscular bite of intestine is taken, and the suture is then passed out of the abdomen. Four sutures are placed in a diamondshaped configuration, providing both
T-fasteners through the abdominal wall and anterior gastric wall.