Indication for Surgery
Spontaneous evisceration status post ex-lap
Preoperative Diagnosis
Same
Postoperative Diagnosis
Same
Operation
Reexploration of laparotomy
Reconstruction of abdominal domain with biological mesh
Anesthesia
Gen. endotracheal anesthesia
Estimated Blood Loss
Minimal
Urine Output
Not applicable
Findings
Complete dehiscence of the fascial plane. Prolene sutures torn through fascia. No evidence of enterotomies
Specimen(s)
None
Complications
None
Technique
This is a very unfortunate 64-year-old gentleman well-known to the surgical service. Patient had a coughing spell this afternoon and felt a pop of his abdomen. On examination the patient had a complete evisceration and fascial dehiscence. Patient was taken urgently to the operative theater placed in supine position surgical timeout was done to identify patient location as well as operation to be performed. Intubated and prepped and draped in a standard surgical fashion. The previous suture was removed the retention suture was removed. The bowel was then carefully dissected off the fascial edges. Copious irrigation was used a 30 x 12 cm biological mesh was then placed underneath the fascial plane and sutured to the anterior abdominal wall using a parachute technique 6 sutures were used total. We had a minimum of 2 cm coverage throughout the whole fascial plane. 10 mL of a cell powder was applied to the logical mesh anteriorly. This was covered by Xeroform. And a wound VAC was then applied over the mesh. Sponge and needle counts correct ×2. The patient will remain intubated for postoperative recovery.
Kelly – CPC