STEPS OF THE OPERATION:
Skin cut for 2-3 inches to expose the ext. obl. apo. (EOA)
EOA cut to expose ing. canal and hernia sac excised
Upper leaf sutured to ing. lig.
Incision taken in sutured leaf
EOA strip is seperated
Upper border of strip stitched to muscle arch to form new floor
Ing. canal closed
Absorbable subcuticular stitch
Scar after 8 days
Thin EOA can be used effectively Separated fibers of EOA & large dilated sup. ring is no bar for this repair if few tiny loop sutures taken to keep separated fibers together
OPERATIVE PHOTOTGRAPHS OF 4 LAYER VENTRAL HERNIA REPAIR
First layer suturing closure of the hernia defect with multiple interrupted sutures and opening of the rectus canal on both sides. Medial and lateral flaps of opened rectus canal with recti muscle in between is seen.
Second layer suturing of medial flaps of anterior rectus sheath with running sutures in front of the first layer closure of the hernia defect. Recti muscles and edges of lateral flaps are seen.
Third layer suturing of both recti muscles in the midline with multiple interrupted sutures in front of the second layer of the suturing.
Fourth layer suturing of the lateral flaps of the anterior rectus sheath in the midline with mattress sutures in front of the sutured third layer.