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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
Self Check: Question 2
4Ventral Hernia Repair
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
Component Separation
Self Check: Question 3
5Ventral Hernia Repair
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
Component Separation
Self Check: Question 4
6Ventral Hernia Repair
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
Component Separation
Self Check: Question 5
7Ventral Hernia Repair
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
Component Separation
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
10Ventral Hernia Repair Onlay Position
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
Self Check: Question 1
11Ventral Hernia Repair
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
Self Check: Question 2
12Ventral Hernia Repair
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
Self Check: Question 3
13Ventral Hernia Repair
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
Self Check: Question 4
14Ventral Hernia Repair
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
Self Check: Question 5
15Ventral Hernia Repair
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]
16Ventral Hernia Repair Onlay Position
Self Check (Part 5)Questions: Retrorectus Underlay Procedure
17Ventral Hernia Repair Retrorectus Underlay/Sublay Position
18Ventral Hernia Repair Onlay 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
19Ventral Hernia Repair
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
Self Check: Question 2: Retrorectus Underlay Procedure
20Ventral Hernia Repair
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
Retrorectus Underlay/Sublay Position
Self Check: Question 3: Retrorectus Underlay Procedure
21Ventral Hernia Repair
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
Retrorectus Underlay/Sublay Position
Self Check: Question 4: Retrorectus Underlay Procedure
22Ventral Hernia Repair
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
Retrorectus Underlay/Sublay Position
Self Check: Results [Retrorectus Underlay Procedure ]
23Ventral Hernia Repair Onlay Position
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
25Ventral Hernia Repair
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
26Ventral Hernia Repair
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
Strattice® Underlay Technique in the Intraperitoneal Position
Self Check: Question 2: Underlay Technique in the Intraperitoneal Position Procedure
27Ventral Hernia Repair
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
Strattice® Underlay Technique in the Intraperitoneal Position
Self Check: Question 3: Underlay Technique in the Intraperitoneal Position Procedure
28Ventral Hernia Repair
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
Strattice® Underlay Technique in the Intraperitoneal Position
Self Check: Question 4: Underlay Technique in the Intraperitoneal Position Procedure
29Ventral Hernia Repair
Which of the following statements is/are true when implanting the mesh in the underlay intraperitoneal position? Select all that apply.
Strattice® Underlay Technique in the Intraperitoneal Position
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
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