Sachin B Jamma, MS, MNAMS, FMAS, DipALS, Balasaheb G Shitole, MS. Ashwini Rural Medical College,Solapur
Objective: Correct placement of the mesh around the defect is always a cause of anxiety in Surgeon’s mind, especially for beginners. Various methods are described to place IPOM accurately however they come with a cost. Purpose of the study was to find out a simple, no cost method to place IPOM accurately around the defect in ventral hernias especially for countries with limited resources.
Methods and Procedures: Basic principles of IPOM surgery observed in study were the overlap of mesh has to be 5 cm all around the defect , mesh should never touch the bare skin and perfect asepsis. The study was performed on sixteen randomly selected patients posted for IPOM or IPOM plus after thorough clinical examination and investigations. Size of defect was judged earlier however intra operatively size of the defect was measured by using spinal needle technique in all sixteen cases. The defect was marked externally on skin with marker pen. The size of IPOM was selected so as to get an overlap of 5cm all around the defect. Once the size of mesh was decided, after changing the gloves, mesh was delivered from sterile foil to a separate sterile instrument trolley. While changing the gloves the sterile paper glove cover/glove bag was preserved. The mesh edges were drawn on this sterile paper glove cover with marker pen. Just outside the marked edges of mesh, points of transfixation sutures (2 or 4–as per the plan of surgery) were plotted. Then this paper glove cover with markings was placed on anterior abdominal wall after deflating pneumo so that the defect will be in the centre of the sketch with a 5cm overlap. The points of transfixation were now marked on abdominal wall puncturing the points marked on paper with a marker pen so that skin puncture later will be at these points for transfixation sutures. Rest of the surgical procedure was carried out as planned.
Result: With this technique, we observed precise and perfect placement of the mesh in all sixteen cases with an overlap of 5 cm all around the defect. Inraoperative Revision was not needed in any case.
Conclusion: This simple, cheap technique using a paper glove cover will definitely ease Surgeon’s life on table avoiding contact of mesh to skin & achieving a good 5 cm overlap of mesh to the edge of defect.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94341
Program Number: P592
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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