Jessica Marshall, DO, John A Primomo, MD, Shinil Shah, MD. UT Memorial Hermann
Description of Procedure: Initial laparoscopic inspection confirmed a large anterior diaphragmatic hernia containing a segment of transverse colon and omentum. Gentle traction was used to reduce the hernia contents, taking special caution to prevent bowel injury or deserosalization. After inspection of the reduced contents revealed no injury, attention was then paid to the hernia defect. The defect was measured to be approximately 6cm. Using a LigaSure device, the posterior aspect of the hernia sac comprising approximately 60% of the sac was carefully dissected away from the right chest cavity and pleura. The remainder of the sac was left intact as we felt mobilization and dissection could risk injury to mediastinal structures or lung parenchyma. Upon inspection of our remaining defect it was felt that it would be closed primarily with minimal tension so we placed interrupted 2-0 Vicryl sutures to close the defect and a 12 cm Parietex mesh was chosen for reinforcement. The distal aspect of the falciform ligament was taken down with the LigaSure device to allow for appropriate mesh placement. The AbsorbaTack sutures were placed circumferentially around the mesh for 270 degrees at the anterior, posterior and right lateral positions, however we chose to placed interrupted sutures of 0 Vicryl at the left lateral position to reduce risk of injury to the pericardial structures. A final inspection revealed adequate hemostasis and no injury to visceral structures.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87409
Program Number: V268
Presentation Session: Friday Video Loop (Non CME)
Presentation Type: VideoLoop
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