Laparoscopic Repair of Swiss Cheese Incisional Hernia: A Comprehensive Video Overview скачать в хорошем качестве

Laparoscopic Repair of Swiss Cheese Incisional Hernia: A Comprehensive Video Overview

Swiss cheese hernia, a term often used to describe multiple small defects in the abdominal wall, presents a unique surgical challenge. These defects are so named due to their resemblance to the holes in Swiss cheese. Commonly occurring after abdominal surgeries or trauma, these hernias involve multiple, closely situated small defects, often located in the anterior abdominal wall, and are commonly associated with incisional hernias. Laparoscopic repair of Swiss cheese hernia has emerged as an effective, minimally invasive approach, offering advantages over open surgery in terms of reduced postoperative pain, shorter hospital stays, and faster recovery. Anatomy and Etiology Swiss cheese hernias typically arise due to fascial weakness, often following previous surgeries or infections that compromise the integrity of the abdominal wall. These multiple defects are separated by strands of connective tissue, making them difficult to repair via conventional open techniques. Swiss cheese hernias can vary in size, ranging from small, sub-centimeter defects to larger ones, which may lead to herniation of intra-abdominal contents such as omentum or bowel loops. The etiology includes: Previous abdominal surgeries (incisional hernias) Trauma to the abdominal wall Congenital defects (less common) Conditions that increase intra-abdominal pressure such as chronic cough, obesity, or pregnancy Clinical Presentation Patients with Swiss cheese hernia often present with bulging of the abdominal wall, discomfort, or pain, particularly with activities that increase intra-abdominal pressure. If bowel loops become trapped within these defects, it can lead to complications like bowel obstruction or strangulation, necessitating urgent intervention. Palpation of the abdomen may reveal multiple hernial sacs under the skin. Indications for Laparoscopic Repair The laparoscopic approach is particularly beneficial in cases of multiple defects, as it provides a panoramic view of the entire abdominal wall, allowing the surgeon to assess and address all defects in a single procedure. Indications for laparoscopic repair include: Symptomatic Swiss cheese hernia with associated pain or discomfort Recurrent hernias following previous open repairs Multiple defects unsuitable for conventional open repair Preoperative Considerations Laparoscopic Technique Patient Positioning and Access: The patient is placed in a supine position, and pneumoperitoneum is established using a supraumbilical or infraumbilical Veress needle or trocar. Additional working ports are introduced, usually 3-4 in total, depending on the size and location of the hernias. A supraumbilical port placement is commonly preferred to gain better access to the abdominal wall defects. Identification of Defects: Once the abdomen is insufflated, the hernial defects are visualized. In Swiss cheese hernia, there are multiple defects separated by intact fascia. The laparoscopic camera provides a wide view, allowing the surgeon to inspect the entire anterior abdominal wall for any missed defects. Adhesiolysis and Reduction of Hernial Contents: Adhesions between the hernia sac and abdominal contents (usually omentum or bowel) are carefully dissected and reduced into the peritoneal cavity. Adhesiolysis may be needed, especially in cases of recurrent hernia. Mesh Placement: The preferred method for laparoscopic repair of Swiss cheese hernia is the use of a large mesh that can cover all defects in one application. This may be a composite mesh or a biologic mesh, depending on the patient’s condition and the surgeon’s preference. The mesh is positioned to cover the entire area containing defects with a significant overlap (usually 3-5 cm beyond the margins of the defects) to prevent recurrence. The mesh can be secured using tackers, sutures, or fibrin sealants. Closure of Larger Defects: In cases where some of the larger defects are present, primary closure may be attempted prior to mesh placement. This can be achieved using intracorporeal suturing techniques or with the aid of barbed sutures to approximate the fascial edges. Advantages of Laparoscopic Repair Minimally Invasive Approach: Compared to open repair, laparoscopic surgery results in smaller incisions, reduced pain, and quicker recovery. Better Visualization: The laparoscopic view allows for better identification and repair of all defects, reducing the risk of missing small hernias. Reduced Complications: The reduced tissue handling in laparoscopic surgery minimizes the risk of wound infections and other postoperative complications. Contact us World Laparoscopy Hospital Cyber City, Gurugram NCR Delhi, India World Laparoscopy Training Institute Bld.No: 27, DHCC, Dubai, UAE World Laparoscopy Training Institute 5401 S Kirkman Rd Suite 340 Orlando, FL 32819, USA