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Saturday, December 05, 2009

Appendicular Hernia

Very interesting case.

This lady had an incisional hernia where her umbilicus should have been. She had undergone an abdominoplasty (like a tummy tuck / liposuction) someplace and had come here for the hernia which had recently become irreducible. The plastic surgeon who did the abdominoplasty obviously wasn't very good at his job because along with the obvious incisional hernia, he also managed to give her some really ugly dog-ears at either end of her scar!

Anyway, we went in laparoscopically and as expected we found a large defect with the previous surgical sutures cutting through the sheath. The contents were clearly bowel and we started reducing them into the abdominal cavity. As we reached towards the end, we realised that the lead to the contents was actually her appendix. It formed the engine that led the entire train of bowels to enter through the defect and lie in the subcutaneous tissue!

We started the meshplasty using our technique of unabsorbable sutures and a port closure needle. Somewhere between the 2nd and 3rd tie, the needle bent to such an angle that we thought it was broken for good. To make matters worse, the only other needle in the OT was unsterile, and the needle from our personal set was not with us at that point in time. We sent the 2nd needle for sterilisation and tried innovative methods in the meanwhile to try and continue the sutures. We tried using a Veress Needle (didn't work), intracorporeal suturing (worked for distant sutures but not for the ones close to the camera port and tackers.

Finally after prolonging for an hour unnecessarily, we got the second needle and finished the case in 3 hours for what should have taken us 1.

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