Riparazione laparoscopica di duplice ernia della parete addominale di confine (ernia di spigelio sn associata ad ernia inguinale omolaterale). LucaFelicioni Ospedale Misericordia Grosseto ITA
trocar setting
Pz di sesso maschile di 72 anni,obeso (BMI27.4),portatore di ATS generalizzata con pregressa TEAC sn e terapia con cardioasa.Riferisce ernia inguinale primitiva riducibile di circa 2cm dia max(EHS class.PL2) e probabile ernia spigeliana sn asintomatica ma visibile per alterazione del profilo cutaneo confermata alla ect della parete addominale di circa 3cm dia max(EHS class.Lmedium).
Induzione di pneumoperitoneo Verres-assistita ed introduzione degli altri trocar nell’emisoma controlaterale(10-10-5).Presenza di ernia inguinale sn obliqua esterna di 2cm dia max ed ernia spigeliana sn con impegno lipomatoso.Preparazione della tasca peritoneale unica con asportazione del grasso prefasciale sino ad individuare l’incrocio tra i vasi epigastrici inferiori,la linea arcuata e la fascia posteriore del m.retto sn.a questo livello riduzione del lipoma preerniario e reperto di lacuna interfasciale di circa 3cm dia max.Preparazione e sezione dei vasi perforanti a partenza epigastrica.Preparazione del piano fasciale sino alle fossette otturatoria (mediale) ed iliaca (laterale) con parietalizzazione degli elementi funicolari ,del deferente e dei vasi epigastrici.Posizionamento,dopo riduzione di lipoma preerniario,di mesh tipo ultrapro 15cmx15 con overlap di circa 4 cm su entrambe le lacune fasciali fissato con tre punti cardinali in prolene 3/0 transfasciali e cianoacrilato sul bordo libero.tacs assorbibili sul bordo iliaco e sul muscolo retto.desuflazione e chiusura delle breccie fasciali a punti staccati.
7 thoughts on “laparoscopic spigelian and inguinal hernias repair”
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