are very many other action taken for the repair of abdominal wall defects, iatrogenic origin or not.
Whatever the intervention to be performed and whatever the technique used, the instrument should first carefully read the leaflet of the prosthesis that will be used and to know the following:
1. Type of prosthesis
- Absorbable , partially absorbable, nonabsorbable
assorbibilisi prosthesis in use or you can use wire crimps or absorbable. In the partially absorbable and nonabsorbable implants are used wire crimps or not absorbable.
absorbable implants may need to be subjected to immersion in a specific solution for better handling and adaptation to the surface. - Transparent, Opaque
transparent implants allow the surgeon to better control the positioning of the prosthesis to the defect to be corrected, which can not happen with those opaque. Typically, the transparent part of a substance is absorbed long stay. - Shaped ,
non-shaped implants can be shaped for application to specific laterality (in laparoscopic inguinal hernia) or have a form for which you can direct them as needed (prosthesis with ellipsoidal shape where you can exploit the larger diameter and smaller).
implants shaped and unshaped not be used as the manufacturer and can not be cut. Those can be shaped to be adjusted before and during the placement and fixation. - Double surface, surface Mono
double surface implants are typically equipped with a porous surface / cross-linked be applied to the fascial surface of the abdominal wall and a smooth and soft as to leave contact with the bowel loops.
The smooth surface should always be kept intact and must be properly identified especially if the implant is transparent or translucent. The porous surface
/ crosslinked strongly stimulates the scarring process and production of fibrous tissue. For this reason, the malposition should be avoided at all costs for which the reticulated surface is in contact with the abdominal viscera. This could cause very dangerous phenomena adhesions.
monostructural implants, both surfaces have cured, and then impossible to leave contact with the intenstinali alliances. Pears to be applied to the inner surface of the abdominal wall must be inserted into a peritoneal pocket, so that the loops do not come into contact with the prosthesis. The tool then must prepare the tools for the creation of the pocket and its closure after setting of the prosthesis. - be shaped, unshaped
non-shaped implants can not be upgraded and should be useful choices in size to cover the defect.
be shaped implants can be cut to be adapted to specific locations. The prosthesis should not be shaped cut with thermal devices, but with very sharp scissors. The waste must be removed immediately from field to avoid an accidental retention. - Synthetic, Biological
synthetic prostheses are those with the greatest use because of the relatively low cost and the almost total anallergenicità. Those are intended to more fully integrate biological tissue as possible. The former do not require special treatment prior to their placement, while the second is often accompanied by pre-treatment necessary so that they can be adapted and positioned to the fullest. Generally, biological implants have a very high cost and may face rejection.
2. Warnings Warnings
in the use of a prosthesis of the abdominal wall are:- that the package is complete, both the external and internal
- Check the expiry date and dimensional data of the prosthesis
- Remove the prosthesis directly from the server room to
- Handle the prosthesis with gloves clean and free talcum powder, to prevent them trapped in the mesh of the prosthesis
- The prosthesis of the abdominal wall should be used with the best conditions of sterility on non-contaminated. The contamination can cause an infection that prevents the prosthesis from taking root.
- implants of abdominal wall should not be used in children and pregnant women, where the abdominal area can avere trasformazioni dimensionali.
- Nel posizionamento di una protesi in videolaparoscopia, è necessario che sia posizionato un trocar di almeno 10 mm. di diametro per consentire alla protesi di entrare in cavità.
3. Preparazione delle protesi
La preparazione di una protesi di parete dipende dalla tecnica impiegata per il suo posizionamento. In chirurgia open la protesi viene generalmente posizionata come si presenta all'apertura della confezione, o può subire delle sagomature relative al luogo nel quale verrà posizionata.
Nella chirurgia videolaparoscopica la protesi non viene solitamente sagomata, ma arrotolata per poter passare attraverso il trocar.
Le protesi sintetiche non necessitano pre-wetting, but instead may be marked for orientation. E 'dermographic can use a pen or a suture.
biological or partially absorbable implants undergo a pre-wetting that restore softness and flexibility. It is used in normal saline to 9% or Ringer lactate solution, or indicated by the manufacturer. Wetting can be performed within the blister where the prosthesis is retained and can last a few seconds.
If the prosthesis should be rolled to pass through a find, this is then grasped with forceps and Johanne introduced.
4. Positioning of the prosthesis implants can
be positioned and then fixed, or can be placed with a fixing point which then allows a subsequent shaping. The important thing is that the prosthesis is well spread over the surface, avoiding the production of folds. If the prosthesis is a double surface is crucial that these be placed conveniently.
to attach the prosthesis can be used wires not absorbable, monofilament mainly because of their elasticity and smoothness. In laparoscopic surgery are used for fixing crimp in various shapes and may be nonabsorbable or absorbable. During their placement is made a counter that allows them to penetrate deep into the thickness of the wall.
If you have used cross-linked implants without a smooth surface, the surgeon first makes a pocket of peritoneal chamber, then placed and fixed the prosthesis and finally closes the peritoneal pocket with wires or crimp.
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