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Laparoscopic component Separation in complex ventral hernias. Initial experience in a Hernia Clinic in Colombia.

Evelyn Dorado, MD, Jesica Correa, MD. Fundacion Valle Del Lili

INTRODUCTION: Complex hernias require special management, the first 12 months the relapse of primary closure  is between 40-50%. Laparoscopic techniques such as the IPOM are reserved for defects of <10 cm, recurrences or major defects require techniques like components  separation , which previously were only performed open but can now be done by laparoscopy. Integral management merits hernia centers, in Colombia there are no hernia centers, in Fundacion Valle del Lili  we have the first specialized center for this type of patients.

METHODS AND PROCEDURES: Descriptive, 4 patients were schedualed between December 2016 and July 2017 to eTEEP Rives Stopa repair. 2 male and 2 female patients, mean age 40 years, 1 patient with BMI 50, 1 patient BMI 34 and 2 patients with 26, 2 of them with 2 previous repairs with failed mesh one with hepatic transplant, 1 with recurrence of  IPOM and one with a defect Secondary to an intestinal resection without prior repair. Diameter of defects between 10 and 20 cm.

RESULTS: All patients were studied with CT Scan to determine the size of the hernia and the contents of the sac, all were schedualed for eTEEP RS, I used a balloon for the preperitoneal, technique of 5 trocars , first step: dissection of the space,second:  reduction the content of the sac, one patient  requiered remove a composite mesh, posterior and anterior fascia closure with bearded suture and placement of polypropylene mesh 30X30 cm medium weight and fixation with fibrin sealant. All patients required drainage and 1-day hospitalization. At 7 days removed the drain and started of physical therapy for strengthening with exercise hypopresives. Control of the first two patients with CT at 3 months without relapse. No operative site infections.

CONCLUSION: The benefits of laparoscopy are recognized, the use of this technique in complex defects has proven effective and has a positive impact on the quality of life of the patient. This type of procedure requires trained personnel and a hernia clinic to ensure interdisciplinary management and follow-up to ensure results.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 84795

Program Number: P008

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

40

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