Endoscopic Subcutaneous Approach to Component Separation

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Presentation transcript:

Endoscopic Subcutaneous Approach to Component Separation Jorge Daes, MD, FACS Journal of the American College of Surgeons Volume 218, Issue 1, Pages e1-e4 (January 2014) DOI: 10.1016/j.jamcollsurg.2013.09.020 Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 1 The semilunar line, lateral to the rectus abdominal muscle, is identified and marked on the skin bilaterally, under ultrasound guidance. Journal of the American College of Surgeons 2014 218, e1-e4DOI: (10.1016/j.jamcollsurg.2013.09.020) Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 2 A balloon is introduced and is advanced over the anterior aponeurosis until the tip reaches the costal margin. The balloon is inflated at 2 levels using 8 to10 pumps. Journal of the American College of Surgeons 2014 218, e1-e4DOI: (10.1016/j.jamcollsurg.2013.09.020) Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 3 The space is maintained with CO2 insufflation to a pressure of 10 mmHg. An additional 5-mm port is introduced lateral to the camera port. Journal of the American College of Surgeons 2014 218, e1-e4DOI: (10.1016/j.jamcollsurg.2013.09.020) Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 4 The external oblique aponeurosis is incised lateral to the left semilunar line using the marking on the skin as guidance. Journal of the American College of Surgeons 2014 218, e1-e4DOI: (10.1016/j.jamcollsurg.2013.09.020) Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 5 The extension of the component separation is shown. We have measured it to be more than 8 cm at the waistline. Journal of the American College of Surgeons 2014 218, e1-e4DOI: (10.1016/j.jamcollsurg.2013.09.020) Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 6 Suture closure of a ventral hernia using a self-retaining continuous suture. Journal of the American College of Surgeons 2014 218, e1-e4DOI: (10.1016/j.jamcollsurg.2013.09.020) Copyright © 2014 American College of Surgeons Terms and Conditions