- Supine, arms out, iodine drape
- Ports
- 3 x 5mm ports as lateral as possible on one side, after safe pneumoperitoneum
- Left subcostal if no previous surgery in this area
- Dissection
- Sharp/blunt dissection of adhesions, no diathermy (most important part of operation!)
- Inspect bowl immediately if close to r/o injury
- Adhesions to the sac – can divide sac and leave it on bowel, apply external pressure to the sac
- Post-adhesiolysis
- Use spinal needle from outside to delineate edge of hernia
- Mark on the outside
- Decompress pneumoperitoneum and mark 3cm out from edge of hernia
- Take mesh (Goretex dual mesh) and cut to marked size on abdominal wall
- Mark mesh for orientation
- Mesh placement
- 2x further 5mm ports on opposite side
- Place 4 x sutures (0 Prolene) to corners and then place into abdomen with smooth side down
- Bring pre-placed sutures out at pre marked area (scalpel incision at this spot)
- Tie knots down on to fascia, use local here as can be sore
- Reduce insufflation pressure to 10mmHg
- Absorbitac around the edge of the mesh + sutures (with suture passing device) every few cm
- Close 5mm ports