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Repair of a Monstrous Ventral Hernia with the Sandwich Technique
Surgery performed in The Republic of Panama
Please be patient and continue watching
Please be patient
Cancer of ***
Abdominoperineal Resection 2007
Radiotherapy 2007
Previous Ventral Hernia Repair in 2008
We will show you, how we did the Sandwich Technique
First we will you, photos of our patient before the surgery
Here we watch the hernia with our patient standing
The colostomy at your right hand
Photos in supine position
Moments before the surgery
Tomography of the hernia
Analogy of the Sandwich Technique
Onlay mesh and Intraperitoneal mesh
And the fascia between them.
The fascia and muscle is the fundamental
to the success of this kind of repair
Hope you understand the diagram
Beginning of the surgery
Incision around the hernia sac
Plane between the hernia sac and the skin, exposed
Another angle
Mesh of the previous attempt of repair
Hernia defect
Arrows pointing the mesh
Mesh out
Starting to fix the intraperitoneal mesh
Anchoring the transfascial points
Another angle of the transfascial points
With our hands we are protecting the bowells
Tying the knots
Our intraperitoneal mesh fixed
Reinforcements points around the mesh and abdominal wall
We opened the anterior sheet of the abdominal ***
The contralateral *** in the same way
We are approximating both fascia sides
We are tying with sutures at the abdominal midline with fascia from both ***
You are watching the fascia plane, we created
We are measuring the onlay mesh
Fixing the onlay mesh with clips, in 2014 we are using absorbable suture
Now we are putting the drainage
Over the onlay mesh
We cut the excess of skin
And we close skin in two planes, subcutaneous and epidermis/dermis
Now we will present our results
Our patient at seven days post-operative
The difference before and after the surgery
Discussion
The Sandwich or Mix Technique
Give more stability to the abdominal wall
Better esthetics
Compared with the literature, this technique
is useful in repairing complex areas
with huge defects
You will not find a lot of literature, about the repairing of complex hernias with monstrous defects
Thank You for watching this video, is a pleasure for us