Fixation of the Mesh
| Discussion in 'All Categories' started by Dr. Srinivash - May 23rd, 2016 6:41 am. | |
Dr. Srinivash
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During Laparoscopic Hernia Surgery is it necessary to fix the mesh on cooper ligament? |
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re: Fixation of the Mesh
by Dr.S.Hussain -
May 27th, 2016
11:06 am
#1
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Dr.S.Hussain
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Thank you Dr. Srinivash Yes, Mesh is fixed medially over the Cooper's ligament and pubic bone using an implant. A proline mesh of appropriate size, usually 15X15 cm should be taken and one corner of Mesh should be tailored. Mesh should be rolled and loaded backward in one of the port. Mesh is placed inside the abdominal cavity through 12mm port. If surgery is being performed by 10mm port only the port should be removed and rolled mesh should be introduced though the port wound directly. After introduction of mesh it is unrolled when it reaches in peritoneal cavity. Mesh is fixed medially over the Cooper's ligament and pubic bone using a tacker or anchor. Tailored corner of mesh should be positioned infero-medially. No lateral slit should be made in the mesh and it should not be fixed lateral to cord structures to prevent injury to lateral cutaneous nerve of thigh. The mesh in this position covers the direct, indirect and femoral defects. It is essential that mesh should extend below the pubic tubercle so that it covers the femoral orifice. Mesh should also extend medially to cover all the possible orifices of hernia. Laterally mesh should project at least 2 to 3 cm beyond the margin of deep ring. If mesh is not of appropriate size, the chance of recurrence is high. Sometime, surgeon may be disoriented and mesh is placed with its long axis vertical instead of transverse. If mesh is cut at one of the corner chances of this disorientation is minimum. |
