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As you do not perform complete peritonisation...
Moderator(s): Amy Cassini
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12/19/2014 at 3:26:55 AM GMT
Posts: 36
As you do not perform complete peritonisation...

As you do not perform complete peritonisation, do you have any case of bowel erosion, if it contacts the mesh?
by cvetkoff


12/23/2014 at 7:33:29 PM GMT
Posts: 0
No !
We realise always peritonisation with VICRYL 2/0 or Mersuture 2/0
We had one case of Bowell incarceration 6 months after a LSC

BD


1/8/2015 at 2:08:25 PM GMT
Posts: 7
I also always close the peritoneum completely. I have found that simple technique includes using two 15cm looped barbed sutures (V-locs work well.) Start midway between the promontory and the vagina and suture towards the promontory with the one and then go back to the middle and with the second one suture towards the vagina.


1/9/2015 at 6:42:41 PM GMT
Posts: 9
We always close the peritneum as well....we don't always completely close it as the true goal of retroperitonealization of the mesh is to eliminate the opening on the right pelvic sidewall that a piece of bowel could go between the mesh and the right sidewall and therefore get obstructed in this loop or opening. In the video we presented there was only a small portion of mesh still exposed and we have not had any issue with bowel obstruction or bowel adhesions to this area causing problem if only a small portion is left exposed. Most of the time we do completely cover it with a running 2-0 monocryl suture that we run down, grab the bladder flap and then before running back up to the sacrum, you can backhand the needle and grab the posterior peritoneum by the rectum with a couple bites on the left side of the mesh (this can also be grabbed on the right side of the mesh prior to going up to the bladder flap) and then run it back up to the sacrum to tie it. Remember when colorectal surgeons complete a Ripstein procedure, they leave ALL the mesh exposed that is encircling the rectum.


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