# mesh removal with hernia repair



## herrera4 (Aug 8, 2012)

can mesh removal be coded separetly from hernia

 He was then prepped and draped in the usual sterile fashion using ChloraPrep.  A previous infraumbilical incision was opened. This was extended approximately a centimeter to left and right. This was carried down through skin and subcutaneous tissue. Hernia sac was identified. It was entered. The incarcerated omentum was freed from the hernia sac.  There was a large defect approximately 10 cm noted. Hernia sac in the subcutaneous tissue was stripped to prevent seroma formation. As noted above, the small bowel was densely adherent to the mesh which had disrupted from the lower half of the repair with result of the small bowel being densely adherent to the exposed Marlex. This was meticulously freed from the mesh. No enterotomies were encountered. One small bleeding point on the serosal surface was controlled with two sutures of 3-0 silk. Once the bowel and abdominal contents were freed from the mesh, the mesh was excised from the abdominal wall using cautery and passed off the field. Fascia was refreshened. Remaining sac in subcutaneous tissue was excised and skin flaps were elevated superiorly and inferiorly to allow for tension-free closure. Corner sutures were placed and the resultant defect measured 10 cm.  According, 11 x 14 cm mesh was chosen. This was hydrated, rinsed in Ancef and oriented transversely. This was placed in abdominal cavity with the coated side down. The mesh was then tacked within the Marlex pocket using secure strap, lower half was tacked first. The superior fascial edge was then drawn inferiorly to pretension the mesh and multiple secure straps were used to secure the mesh to the abdominal wall. This offloaded the repair quite nicely which was accomplished primarily using multiple interrupted sutures of #1 Prolene in a figure-of-eight fashion. Care was taken to grab the anterior portion of the mesh with each bite to secure the mesh beneath the repair. The fascial edges came together quite nicely without tension. Additional Ancef irrigation was carried out. Wound was then closed using running 3-0 Vicryl after placing #10 Jackson-Pratt drain in the subcutaneous tissue through a separate stab wound

thanks for any help


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## cynthiabrown (Aug 9, 2012)

if it is recurrent hernia, removl of mesh is bundled


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