Self Check (Part 5) Questions: Component Separation 1 Ventral Hernia Repair Component Separation.

Self Check (Part 5)Questions: Component Separation

1Ventral Hernia Repair Component Separation

Component SeparationLearning Objectives

2

After completing this section, you will be able to: State the purpose for using the component separation technique

in ventral hernia repair procedures Select the appropriate surgical instrument and perform each step

of component separation Name the surgical instruments being used in the surgery Evaluate whether or not additional advancement of component

separation is necessary Suggest two methods of additional advancement List the steps required to perform each method of component

separation additional advancement

Ventral Hernia Repair Component Separation

Self Check: Question 1

3Ventral Hernia Repair

What is the purpose for performing a component separation in ventral hernia procedures? Select all that apply.

It speeds up the hernia repair surgery

It provides stronger tissues with which to attach the mesh

It enables the rectus abdominal muscles to reach each other so they can be sutured together to cover the defect

Post-surgical abdominal function is maintained – most patients are able to rotate their body after healing

Component Separation



Which surgical instruments are used in the component separation when the external oblique muscle is being separated from the internal oblique muscle? Select all that apply.

Kocher clamps are being used to pull the tissue tautly

Electrocautery is being used to dissect the tissues from each other

A Right-Angle clamp is being used to guide the electrocautery Surgical scissors are used to snip and separate the tissues from each other




What are the two methods used for additional advancement of component separation if the two rectus abdominis muscles do not reach each other? Select all that apply.

Posterior Sheath Elevation

Anterior Sheath Elevation

External Oblique Muscle Elevation

Internal Oblique Muscle Elevation




When is it necessary to use additional advancement techniques for component separation? Select only one answer.

When about one or two more centimeters will enable the rectus abdominis fasciae to meet comfortably

When the rectus abdominis fasciae meet comfortably

When the external oblique muscle can’t be separated from the internal oblique muscle

When the defect is smaller than one to two centimeters




Which procedure provides the most advancement after performing the component separation? Select only one answer.

Separating the external oblique muscle from the abdominal wall

Making an incision in the middle of the rectus abdominis sheath

Separating the anterior sheath from the rectus abdominis muscle laterally

Separate the posterior sheath from the rectus abdominis muscle medially


Self Check: Results [questions component separation]

8Ventral Hernia Repair Component Separation

Self Check (Part 5)Questions: Onlay Position

9Ventral Hernia Repair Onlay Position

Onlay PositionLearning Objectives


After completing this section, you will be able to: Perform the steps to implant the Strattice® Tissue Matrix

using the Onlay (Overlay) position

Identify the appropriate surgical condition in which Strattice® Tissue Matrix can be positioned in the Onlay position

Explain how to prepare the Strattice® Tissue Matrix before proceeding with the implant

Explain how the Strattice® Tissue Matrix will be sutured and to which tissues

Name advantages of using the Onlay position



What is the other term to used to describe implantation of the Strattice® Tissue Matrix in the Onlay position? Select only one answer.

Underlay

Inlay

Sublay

Overlay

Onlay Position



Which surgical condition is necessary in order to place the Strattice® Tissue Matrix in the onlay position? Select only one answer.

Before the rectus abdominis fasciae has been closed with sutures

After the rectus abdominis fasciae has been closed with sutures

When the hernia defect is so large, that the rectus abdominis fasciae cannot be sutured together

Only if the patient has an infection around the site of the hernia

Onlay Position



Which statements are true when preparing Strattice® Tissue Matrix for implantation? Select all that apply.

The mesh must soak in either sterile saline solution or sterile Lactated Ringer’s solution prior to implantation

The mesh must soak in either sterile saline solution or dextrose 5% solution prior to implantation

The mesh must soak in the solution at room temperature for 4 hours prior to implantation

The mesh must soak in the solution at room temperature for 2 minutes prior to implantation

Onlay Position



What is the purpose of using quilting stitches after the Strattice® Tissue Matrix has been sutured on the sides, top and bottom? Select all that apply.

The quilting stitches secure the mesh to the rectus abdominis fascia, thereby reducing tension on the closure

It is less likely that fluid that gets between the mesh and the rectus abdominis fasciae will lift the mesh upwards

Fewer stitches on the sides are needed

The risk of infection is reduced

Onlay Position



Sometimes a mesh is not used in hernia repair. Which of the following are advantages for using a mesh in repairing hernias? Select all that apply.

The mesh provides added support of the closure, thereby helping to reduce tension on the sutures holding the fasciae together

The mesh reinforces the weakness that was created when the external oblique fascia were divided

The risk of incisional hernia recurrence secondary to hernia surgery may be reduced

The implanted mesh may enhance the function of the external oblique muscles on both sides by pulling the muscles toward the midline

Onlay Position

Self Check: Results [onlay procedure]


Self Check (Part 5)Questions: Retrorectus Underlay Procedure

17Ventral Hernia Repair Retrorectus Underlay/Sublay Position


After completing this section, you will be able to:

Perform the steps to implant the Strattice® Tissue Matrix using the retrorectus underlay (sublay) position

Identify the appropriate surgical condition in which Strattice® Tissue Matrix can be positioned in the retrorectus underlay position

Identify the two types of sutures that can be used when stitching the mesh laterally to the anterior rectus sheath

Name the advantage of implanting the Strattice® Tissue Matrix the retrorectus underlay position

Retrorectus Underlay/Sublay PositionLearning Objectives

Self Check: Question 1: Retrorectus Underlay Procedure


What is the other term to used to describe implantation of the Strattice® Tissue Matrix in the underlay position? Select only one answer.

Onlay

Inlay

Sublay

Overlay

Retrorectus Underlay/Sublay Position



Which surgical condition is necessary in order to place the Strattice® Tissue Matrix in the retrorectus underlay position? Select all that apply.

After the rectus abdominis fasciae has been closed with sutures

When the hernia defect is so large, that the rectus abdominis fasciae cannot be sutured together

When the rectus fasciae meet comfortably at the midline

Before the rectus abdominis fasciae has been closed with sutures




What two types of sutures can be used when stitching the mesh laterally to the anterior rectus sheath? Select all that apply.

Apex suture

Quilting suture

Running horizontal mattress suture

Interrupted figure of eight suture




What is the advantage of using the retrorectus underlay position for implanting the mesh in repairing hernias? Select one answer.

The procedure takes less time because there is less suturing involved

Less mesh is required

There’s an additional layer of closure : the mesh can be positioned between the sutured posterior retrorectus fasciae and the sutured anterior rectus sheath

There’s less chance of infection


Self Check: Results [Retrorectus Underlay Procedure ]


Self Check (Part 5)Questions: Underlay Technique in the

Intraperitoneal Position Procedure

24Ventral Hernia Repair Strattice® Underlay Technique in the Intraperitoneal Position

Underlay Technique in the Intraperitoneal Position Learning Objectives


After completing this section, you will be able to:

Perform the steps to implant the Strattice® Tissue Matrix using the underlay procedure in the intraperitoneal position

Identify the appropriate surgical condition in which Strattice® Tissue Matrix would be implanted using the underlay technique in the intraperitoneal position

State the number of centimeters the edges of the abdominis muscles should overlap with the mesh

Calculate the size of the mesh to be measured, given the width of the defect

Identify the two types of suture techniques that can be used when securing the mesh as a bridge in the intraperitoneal position

Strattice® Underlay Technique in the Intraperitoneal Position

Self Check: Question 1: Underlay Technique in the Intraperitoneal Position Procedure


When would it be necessary to perform a ventral hernia surgery using the underlay technique in the intraperitoneal position? Select only one answer.

When the rectus abdominis muscles meet comfortably at the midline

After the rectus abdominis muscles have been sutured together

When the rectus abdominis muscles don’t meet comfortably at the midline When the defect is small




How many centimeters (cm) should the edges of the rectus abdominis muscles overlap with the Strattice® mesh? Select only one answer.

1-2 cm

3-5 cm

6-10 cm More than 10 cm




How wide should the Strattice® mesh be cut if the size of the defect is 10 cm wide? Select only one answer.

10 cm

13-15 cm

16-20 cm 30-50 cm




Which of the following statements is/are true when implanting the mesh in the underlay intraperitoneal position? Select all that apply.


The mesh can be implanted using interrupted figure-of-eight sutures all around or with running horizontal mattress sutures laterally The mesh lays flush against the peritoneum

The mesh is positioned between the posterior retrorectus fascia and the anterior rectus sheath The mesh can act as a bridge if the rectus abdominal muscles don’t meet each other comfortably at the midline

Self Check: Results [Underlay Technique in the Intraperitoneal Position Procedure]

30Ventral Hernia Repair Strattice® Underlay Technique in the Intraperitoneal Position

Self Check (Part 5) Questions: Component Separation 1 Ventral Hernia Repair Component Separation.

Documents

Transcript of Self Check (Part 5) Questions: Component Separation 1 Ventral Hernia Repair Component Separation.