Laparoscopic Ventral Hernia Repair ppt. DR DILIP S.RAJPAL

8/2/2019 Laparoscopic Ventral Hernia Repair ppt. DR DILIP S.RAJPAL

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Jb`jl wh ag`w Kmzwau zqew`wba zwpba

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Bmymuhzjhy`j Vadwumb Naud`m Uaym`u

M jhkyuanadz`va myyuhmjn

GU G@B@Y Z$UMCYMBKZ" KM@Z" [email protected])" FKMZ"

G`yb$ @d Bmyuhzjhy`j zquoaup"Fabbh `d Uhehw`j & Mgv Bmy$ Jhbh+Uajwmb Zquoaup .lhuam qd`v$)

JHDZQBWMDW OAD$ ZQUOAHDBMYUHZJHY@ZW & JHBHYUHJWHBHO@ZW

NHD$ ZQUOAHD DHVM KAG@JMB JADWAUNHD$ MZZ YUHF OUMDW KAG$JHBBAOA & NHD$ ZQUOAHD CC NHZY@WMB

A^+MZZW$ YUHF B$W$K$OAD$ NHZY@WMB


2/47


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Hyad uaym`u kawnhgz

Fhu Vadwumb Naud`mz

G U G @ B @ Y Z $ UM CY MBJHDZQBWMDW OAD $ ZQUOAHDBMYUHZJHY @ZW & JHBHYUHJWHBHO@ZW


3/47

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Wadz`hd uaymù

]q`jl uaymù" ghda qdgau bhjmb mdazwnaz`m

Nhavau wadz`hd uaymù nmz qdmjjaywmebp nònuajquuadja umwaz hf t19!

Uaomugbazz hf wna z`sa hf naud`m" kazn uaymùnmz eaad yuhvag wh ea m zqyau`hu kawnhg



4/47

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Yuhzwnaw`j Kazn Hdbmp wajnd`}qa

Hdbmp kazn uaymùYu`kmup uaymù yaufhukag

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qdgauk`d`do wna zl`d mdg zqejqw fhu m

`ga g`zwmdja

G`zmgvmdwmoazZw`bb m wadz`hd uaymùBmuoa zqejqw g`zzajw`hd jmd bamg wh

zauhkmNòn `dfajw`hd umwa + kmp ea =9+59!



5/47

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@dbmp kazn uaymù

@dbmp kaznZmj a~j`zag mdg kazn zad wh fmzj`mb

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Ynpz`hkazn hu Yuhjaag `f ehab `bb ea `djhdwmjw `wn wna kazn

G`zmgvmdwmoaYhzzèba jhdw`dqag eqboa mfwau uaymù



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Uawuh uajwqz ( Zwhyym uaymù

M ybmda `z g`zzajwag eawaad yhzwau`hu uajwqz

mdg yau`whdaqk wh yqw wna kazn

Wn`z z wadz`hd+fuaa uaymù

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Kqzw qza dhd mgnauadw kazn zqjn mzYnpz`hkazn hu Yuhjaag `f ehab `bb ea `djhdwmjw `wn wna kazn

G`zmgvmdwmoa

Uayhuwag uajquuadja umwa hf t=9!$Uayhuwag`dfajw`hd mdg kazn uakhvmb umwa hf t1+=9!



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Hvauv`a hf vadwumb naud`mz



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Vadwumb mbb .@dj`z`hdmb)

N`onazw `dj`gadja `dk`gb`da mdg wumdzvauza`dj`z`hdz

Qywh 59! mfwau bmymuhwhkp

=(: yuazadw `d 1+=9 pamuz

yhzwhyaumw`vabp U`zl fmjwhuz

Heaz`wp" GK" mzj`waz"zwauh`gz" zkhl`do"kmbdqwu`w`hd" hqdg`dfajw`hd

Wajnd`jmb mzyajwz hf hqdgjbhzquaWpya hf `dj`z`hd A~jazz`va wadz`hd .yuhda wh

fmzj`mb g`zuqyw`hd)G U G @ B @ Y Z $ UM CY MBJHDZQBWMDW OAD $ ZQUOAHDBMYUHZJHY @ZW & JHBHYUHJWHBHO@ZW


9/47

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@dj`z`hdmb Naud`m

Gqa wh fm`bqua hf fmzj`mb w`zzqaz wh nambmdg jbhza

Yuhkhwag ep `dn`e`w`hd hf hqdgnamb`do

=9+=1! hf meghk`dmb `dj`z`hdz

N`onazw `dj`gadja `wn k`gb`da `dj`z`hd



10/47

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@dj`z`hdmb Naud`m

@dg`jmw`hdz fhu Zquoaup Eqboa hf meghk`dmb mbb gaay wh zl`d zjmu Jhzkaw`j jhdjaud vauzqz g`zjhkfhuw_huzadag `wn jhqon`do hu zwum`d`do @djmujaumw`hd

Bazz wnmd =jkKhua wnmd ?+> jk qdb`labp wh `djmujaumwa

Wuamwkadw

Khzw znhqbg ea uaymùag .qdb`la ouh`dnaud`mz)

Zqwqua vauzqz kazn uaymù Zqwqua uaymù `d hda Aquhyamd zwqgp znhag 69!uajquuadja

_`wn hyad kazn uaymù" uajquuadja zaad mw qywh :9!



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1(>(=5

G`modhz`z



12/47

1(>(=5

@dj`z`hdmb Naud`m

V`zèba eqboa + Kmp ea jhzkaw`jmbbp

qyzaww`doYm`d + Kmp b`k`w mjw`v`wàz" ym`d `z `djuamzag

`wn b`fw`do" zwum`d`do mdg jhqon`do

@djmujaumw`hd + Zavaua mjqwa ym`d `wn

wadgaudazz hvau wna naud`m z`waEhab hezwuqjw`hd + Gqa wh mjqwa hu jnuhd`j

`djmujaumw`hd `wn wpy`jmb zpkywhkz

Dhwa3 @d heaza ymwàdwz" naud`m kmp dhw eaav`gadw



13/47

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Z`wa

Aw`hbhop

Ymuw`mb vz$ jhkybawa

Z`kyba vz$ zwumdoqbmwag

Fbq`g mdg abajwuhbpwa zwmwqzHyaumw`va vz$ dhd+hyaumw`va kmdmoakadw

@kyhuwmdw ]qazw`hdz wh Jhdz`gau



14/47

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@dj`z`hdmb Naud`m+G`modhz`z

JW Zjmd + Vaup nabyfqb `d heaza ymwàdwz$Fua}qadwbp" m JW Zjmd `bb uavamb mgg`w`hdmb bazzjb`d`jmbbp hev`hqz naud`mz

Qbwumzhqdg + Kmp ea qzafqb azyaj`mbbp `d hff`ja

zaww`do nad YA `z qdjauwm`d Bmymuhzjhyp + Fhu ymwàdwz `wn ym`d mdg

zpkywhkz zqooazw`va hf naud`m" eqw daomw`va YAmdg `kmo`do zwqgàz



15/47

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@dj`z`hdmb naud`m +g`modhz`z

G`mzwmz`z uajw` vz @dj`z`hdmb naud`mG`mzwmz`z `z m wn`dd`do hu amlad`do hf wna fmzj`mb

kakeumda jhddajw`do wna uajwqz kqzjba @w `z dhw m naud`m mdg oadaumbbp `z mzpkywhkmw`j

mdg `bb dhw bamg wh `djmujaumw`hd$ @w kmp eajhzkaw`jmbbp qdz`onwbp

@w `z qzqmbbp bhjmwag `d wna qyyau meghkad mdgkmp hjjqu zyhdwmdahqzbp

@w `z uajhod`smeba ep `wz g`ffqza dmwqua" laabfhukmw`hd mdg bmjl hf m u`do



16/47

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Zwumdoqbmwag naud`mz

Khzw `kyhuwmdw z`odz Favau

Wmjnpjmug`m

Bhjmb`sag meghk`dmb wadgaudazz

Baqlhjpwhz`z

Yuhjazz `z mjjabaumwag `wn jbhzag+bhhyhezwuqjw`hd



17/47

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@dj`z`hdmb Naud`m Jnh`ja hf wajnd`}qa

Jhkyba~ hyad uaymùz Zwhyym kazn uaymù

Jhkyhdadw zaymumw`hdz uaymù

Bmymuhzjhy`j uaymù

Kqbw`yba fmzj`mb gafajwz gawajwag Bmuoa hd+bmp `dwumyau`whdamb kazn

1 jk kmuo`dmb hvaubmy

Uajquuadw naud`mz mvh`g g`zzajw`hd mw yuav`hqzhyaumw`va z`wa



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Jhdwum`dg`jmw`hdz wh BVNUz

Kmchu bhzz hf meghk`dmb ghkm`d Zavaua gae`b`wmw`hdUazy`umwhup g`zwuazz Yuaodmdjp Yhuwmb npyauwadz`hdUadmb fm`bqua `wn yuazadja hf yau`whdamb

g`mbpz`z jmwnawau



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1(>(=5

Bmymuhzjhy`j wajnd`}qa

Fhu Vadwumb Naud`m Uaym`u



20/47

1(>(=5

Bmy Vadwumb Naud`m Uaymù

Mgvmdwmoaz Bazz ym`d" zkmbbau zjmuz" bazz zhfw+w`zzqa g`zzajw`hd

Ohhg và hf yhzzèba hwnau naud`mz zqjn mz z`zz+jnaaza gafajw" wnqz uagqj`do jnmdjaz hfuajquuadjaz

Gajuamzag hqdg jhkyb`jmw`hdz

Affajw`va khgmb`wp fhu uajquuadw naud`mz wnmw nmvaeaad uaymùag mdwau`hubp .hyad)

G`zmgvmdwmoazKmp zw`bb nmva eqboa

Yhzzèba ehab `dcqup

Zauhkm umwa =1+59!



21/47

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Zquo`jmb wajnd`}qa

Wnuaa zwayz Mjjazz

Mgnaz`hbpz`z

Kazn `dzauw`hd ( f`~mw`hd

Lap jhkyhdadwz3 Uagqja wna naud`m jhdwadwz

Ymwjn wna gafajw `d wna fmzj`m `wn KaznKazn `z `djhuyhumwag `dwh wna meghk`dmb mbb ep wna

ehgp

Ua`dfhujaz wna gafajw `d wna fmzj`m

Zajqua wna Kazn wh wna meghk`dmb mbb Yuavadw khvakadw hf wna kazn yu`hu wh `djhuyhumw`hd



22/47

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Yhuwz ybmjakadw

G`uajw v`zqmb`smw`hd .adwau meghkad fuhk z`waz

mmp fuhk naud`mJhdwuhbbag `dzauw`hd

Ehab yuhwajw`hd



23/47


1(>(=5

Bmymuhzjhy`j uaym`u



24/47

1(>(=5

Wuhjmu Z`waz Zawqy

Bafw Ay`omzwu`j naud`m

Zqyumyqe`j naud`m

Qyyau k`gb`da naud`m

Bhau k`gb`da naud`m



25/47

1(>(=5

Gafajw v`zqmb`smw`hd

Yuhyau g`zzajw`hd `z fmj`b`wmwag ep jhkybawa

v`zqmb`smw`hd @f phq jmddhw zaa wna gafajw Jhdz`gau ybmj`do m fhquwn 1kk wuhjmu

Hyyhz`wa wh wna ybmjakadw hf hwnau wuhjmuz



26/47

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Mgnaz`hbpz`z

Mvh`g znmuy g`zzajw`hd mdg mvh`g ehab

`dcqu`azK`d`k`sa qza hf abajwuhjmqwaup

Nmva wh khd`whuz" hda hd amjn z`ga wh nmvaamzp v`zqmb`smw`hd nad phq jnmdoa z`ga

Wh oaw eawwau mbb+uhqdg v`a hf mgnaz`hdz" laayzn`fw`do `dzwuqkadw mdg jmkaum z`waz



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Gafajw kamzquakadw

Wna kmuo`dz hf wna gafajw kmp ea kmulag hd

wna zl`dWna kazn `z kamzquag mdg wu`kkag wh f`w

_`wn wna zkhhwn z`ga ghd"7+6 bmuoa f`~mw`hdzqwquaz mua ybmjag muhqdg wna kazn mdg w`ag



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Wna a~wadw hf wna gafajw `z mzzazzag$



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Yuhjaag Kazn

YUHJAAG Kazn nmz wh bmpauz Zhfw yhbpyuhypbada kaznHUJ + m wn`d" e`huazhuemeba bmpau wnmw zaymumwaz

`wz zwuhdo" zqyyhuw`va kazn fuhk qdgaubp`dov`zjaum$

YUHJAAG kazn `z m b`onwa`onw jhdzwuqjw`hdwh `kyuhva nmdgb`do fhu bmymuhzjhy`jyuhjagquaz



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1(>(=5

Ynpz`hkazn



31/47

1(>(=5

Zajquazwumy



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Nmdgb`do Yuhjaag kazn ( Ynpz`hkazn

Kazn `z md `dwaudmb yuhzwnaz`z

Kazn `dfajw`hdz jmd ea gavmzwmw`do mdg wnakazn kmp daag wh ea uakhvag

Wnauafhua" kazn znhqbg ea nmdgbag mzayw`jmbbp

Jnmdoa obhvaz eafhua whqjn`do wna kazn

Qza zwau`ba `dzwuqkadwz" mdg dhw nmdgz" whnmdgba wna kazn mz kqjn mz yhzz`eba

Mvh`g a~jazz`va qza hf abajwuhjhmoqbmw`hdnakhzwmz`z



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Kazn hvaubmy

Ymzjmb/z yu`dj`yba`ga kazn hvaubmy hf gafajwg`zwu`eqwaz yuazzqua a}qmbbp hvau bmuoau

zqufmja muam$U G @ B @ Y Z $ UM CY MBJHDZQBWMDW OAD $ ZQUOAHDBMYUHZJHY @ZW & JHBHYUHJWHBHO@ZW


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1(>(=5

Wumdzfmzj`mb zqwquaz

Wumdzfmzj`mb zqwquaz yuavadw kazn kòumw`hd

Wumdzfmzj`mb zqwquaz znhqbg ea yaukmdadw Yuhbada ( Awn`bhd ( Awnèhdg A~jab

Wh yuavadw jnuhd`j yhzw+hy ym`d md mù ldhw `zyuafauuag fhu wumdzfmzj`mb zqwquaz

Fhu Yuhjaag mdg Ynpz`hkazn" wh wumdzfmzj`mbzqwquaz mw jaynmbmg mdg jmqgmg yhz`w`hdz muauajhkkadgag

Mfwau wp`do wna ldhw" yqbb wna wumdzfmzj`mb

zqwquaz fuhk wna zl`d hqwmugz m jhqyba hfw`kaz wh uabamza mdp wadz`hd



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Kazn f`~mw`hd

Wna yquyhza hf wmjl`do `zWh k`d`k`sa mdp gamg zymjazWh nhbg wna kazn jbhza wh wna meghk`dmb mbb fhu

a~jabbadw w`zzqa `djhuyhumw`hd

Vmu`hqz wpyaz hf f`~mw`hd nmva eaad gav`zagGhqeba juhd wajnd`}qa

Ab`k`dmwaz gamg zymja" k`d`k`saz zauhkm fhukmw`hd

Wumdzfmzj`mb zqwquaz mua zw`bb n`onbp uajhkkadgag

Z`doba juhd wmjl`do , mezhuemeba zqwquaz

Z`doba juhd wmjl`do , dhd+mezhuemeba zqwquazf`~mw`hd



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1(>(=5

Yhuw Z`wa Naud`mz

Fhbbh`do BVNUz



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1(>(=5

Wuhjmu Z`wa Naud`m

Wna dj`gadja hf wuhjmu z`wa naud`m nmz eaad

znhd wh ea 9$61! wh 5$>9!K`gb`da" yau`qke`b`jmb yhuw z`waz ouamwau wnmd 1

kk mdg kmga `wn ebmgag `dwuhgqjauz hfwaduazqbw `d `dj`z`hdmb naud`m" `f dhw jbhzag



38/47

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Wuhjmu Z`wa Naud`m

Zau`hqz mjjazz+uabmwag jhkyb`jmw`hdz myyamu

wh ea umua eqw jmd bamg wh `djuamzag khue`g`wpnad wnap gh hjjqu

Ehab wnuhqon yhuw z`waz `z qdjhkkhd mdgjmd ea g`ff`jqbw wh g`modhza$ Hfwad wna

g`modhz`z `z gabmpag" uazqbw`do `d `dfmujw`hd hfwna `dvhbvag ehab zaokadw

Khzw bmymuhzjhy`j zquoahdz mouaa wnmw wnag`mkawau hf wna jmddqbm hu yhuw `z wna z`dobakhzw jhkkhd jmqza hf yhuw+z`wa naud`mz



39/47

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Wuhjmu Z`wa Naud`m

Hvaumbb" `f wna jmddqbm hu yhuw z`wa `z =9 kk hu

bmuoau `d g`mkawau" naud`mz jmd hjjqu" gazy`wayuavadw`va kamzquaz zqjn mz qz`do mdhdjqww`do wuhjmu

Khzw zquoahdz gh dhw uhqw`dabp jbhza bmwaumbyhuw z`waz eajmqza `w `z jhkkhdbp wnhqonw wnmw

wna fmzj`mb mdg kqzjqbmu jhkyhz`w`hd hf wnazaz`waz yhza zqjn b`wwba u`zl hf naud`mw`hd wnmw wnaa~wum w`ka mdg affhuw ua}qùag wh uaymù wnak`z dhw cqzw`fàgNhavau wn`z wnahup `z DHW mezhbqwa



40/47

1(>(=5

Yhuw Z`wa Jbhzqua Wajnd`}qa



41/47


1(>(=5

Jhkyb`jmw`hdz

Bmy Vadwumb Naud`m Uaym`uz



42/47

1(>(=5

Yhzz`eba Jhkyb`jmw`hdz

Adwauhwhkp

_hqdg @dfajw`hd

Kazn @dfajw`hd

Yauz`zwadw Zauhkm

Yuhbhdoag Ym`d

@baqz

Ebaag`do(Nakmwhkm

Uajquuadja

Uazy`umwhup G`zwuazz

Meghk`dmb Jhkymuwkadw Zpdguhka ( @VJJhkyuazz`hd



43/47

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_hqdg mdg Kazn @dfajw`hd

Lap }qazw`hd + @z kazn cqzw m bmuoa fhuaòd

ehgp `d md hwnau`za jbamd zquo`jmb hqdg8

Kmdp hqdgz mua `dfbmkag eqw dhw dajazzmu`bp`dfajwag

@dfajwag hqdgz daag wh ea hyadag Mvh`g a~yhz`do wna qdgaubp`do kazn `f yhzzèba

@dfajw`hdz wnmw `dvhbva yhbpyuhypbada kaznazjmd ea kmdmoag `wn Zquo`jmb gum`dmoa Mdwè`hw`jz

A~j`z`hd hf a~yhzag zaokadwzK`juh+yhuhqz(dhd+yhuhqz aYWFA kaznaz

ua}qùa uakhvmb `d khzw jmzaz eajmqza wnapbmjl w`zzqa `douhwn wnmw jhqbg jhkemw wna`dfajw`hd



44/47

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Zauhkm fhukmw`hd

Wna gavabhykadw hf zauhkm `z vùwqmbbp

oqmumdwaag mfwau bmy `dj`z`hdmb naud`m uaymùmdg yuhemebp mfwau uaymù `wn kazn `doadaumb$

Zauhkmz wpy`jmbbp uazhbva zyhdwmdahqzbp

`wnhqw `dwauvadw`hd mdg mua dhw jhdz`gauag mjhkyb`jmw`hd qdbazz wnap mua jb`d`jmbbpmyymuadw fhu khua wnmd > aalzyhzwhyaumw`vabp

Zauhkm kmdmoakadw Ab`k`dmw`do gamg zymja zqjn mz eawaad kazn

mdg wna meghk`dmb mbb ep qz`do zqff`jàdw wmjlz

Yquza zwu`do zqwqu`do hf wna w`zzqa bmpauzG U G @ B @ Y Z $ UM CY MBJHDZQBWMDW OAD $ ZQUOAHDBMYUHZJHY @ZW & JHBHYUHJWHBHO@ZW


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Jnuhd`j Ym`d

@d U`vaz+Zwhyym hu hwnau hyad kazn

`kybmdwmw`hd" `w hjjquz `d khua wnmd =9! hfymw`adwz

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V`zqmb Mdmbho Zjmba.VMZ)U G @ B @ Y Z $ UM CY MB

JHDZQBWMDW OAD $ ZQUOAHDBMYUHZJHY @ZW & JHBHYUHJWHBHO@ZW


46/47

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Yh`dwz wh uakakeau

Ybmja mbb yhuwz mz fmu mmp mz yhzz`eba fuhkwna gafajw

Z`wjn zjhya yhz`w`hd

Laay `dwummeghk`dmb yuazzqua

N@ON gqu`do g`zzajw`hd mdg

BH_ gqu`do jbhz`do

Mdg vaup `kyhuwmdwbp + KMUL WNA KAZN---



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1(>(=5

WNMDL PHQ

Laparoscopic Ventral Hernia Repair ppt. DR DILIP S.RAJPAL

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