2
Laparoscopic
correction of a cicatricial hernia
after open heart surgery
1
2
In this patient a cicatricial hernia in the upper abdomen has developed after an open heart operation (1,2). The hernia is not too big, but troublesome. A laparoscopic correction is planned. This type of hernia can only be corrected with a mesh, since the tissue can not be sewn together properly.
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8
The mesh can be tacked to the inside of the abdominal wall, but counterpression has to be given from the outside. At the upper side of the hernia this is not possible because this part of the hernia is located deep to the lower part of the thorax. Therefore sutures are used that have been knot to the mesh. The mesh is rolled with the sutures inside (3-6) and brought intraabdominally through one of the working channels (7,8).
9
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14
Once intra-abdominal, the mesh is unrolled at the side of the hernia. The sutures are retrieved with a special hook and tied at the outside. The lower part of the mesh can be fastened with the tackerdevice. In the end the mesh is in the right position (9-14).