# Multiple Hernia repairs



## lynettetaylor (Dec 30, 2014)

Can someone please give me some assistance!!!!? 

A vertical incision was made directly over the most prominent recurrent incisional hernia. Incision was carried down through the subcutaneous fatty tissues to the hernia sac. The hernia sac was circumferentially dissected out and during the course of dissection a piece of old mesh was encountered and this too was dissected away from its fascial attachments. The hernia sac and piece of mesh were passed of to Pathology. A fresh fascial edge had been created. Examination of the abdominal cavity demonstrated three upper abdominal hernias. At least one of these was an incisional hernia. The mid abdomen was palpated and there was an umbilical hernia sac also identified. The further most superior had a fairly wide fascial bridge between it and the other hernias, threfore, the upper abdomen hernia was fixed seperately. The lower three hernias and the umbilical hernia was very narrow, therefore the fascial bridge was taken down. There were five hernias total that were repaired via two seperate incisions. The one that was furthermost superior just below the xiphoid process was through a prior laproscopic site. A transverse incision was made directly over this hernia site and carried down through the subcutaneous fat to the hernia sac. I could palpate the fascial defect intrabdominally. The hernia sac was pushed through and amputated. A small Ventralex patch was placed in this fascial defect, which was closed with interrupted 2-0 Prolene sutures incorporating the Marlex straps in the closure for fixation. Therefore, the hernia was completely closed and completely covered Ventralex patch. The Marlex straps were cut flush with the surface of the fascia. The subcutaneous fat was approximated with a running 3-0 vicryl suture. The skin itself was closed in running subticular fashion using 3-0 Vicryl suture. Dermabond was applied. 
Attention was directed back towards the large recurrent incisional hernia. As mentioned above, the fascial bridge between this recurrent incisional hernia and the umbilical hernia was taken down with electrocautery, and the two smaller upper hernias had the hernia sacs resected. An approximately 14 cm greatest diameter oval Ventrio mesh was selected and placed in the fascial defect, which covered the entire length of the incisional including the two upper smaller hernias. This was anchored at the 12 o'clock and 6 o'clock position with a #1 Novafil suture. The fascia was separated from the overlying subcutaneous fat circumferentially utilizing electrocautery back approximately 5 cm on each side. The patch was then anchored to the periphery of the abdominal wall with at least three #1 Novafil sutures on each side. This nicely covered the hernia defect and there was enough laxity in the fascia to reapproximate the midline fascia over the mesh with two separate double strand 0 Novafil sutures starting in the superior and inferior aspect of the would and running these to the midpoint where they were tied. The closure incorporated the underlying mesh withing the closure to obliterate dead space. The overlying subcutaneous fat was then approximated with running 2-0 Vicryl suture, which was tacked down to the underlying fascia intermittently to obliterate dead space. The umbilicus had been tacked down to the underlying fascia with a singe 2-0 Vicryl suture. The skine was closed with surgical staples.


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## cynthiabrown (Dec 31, 2014)

two incisions...............so you can bill 2 repairs


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