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Laparoscopic umbilical hernia repair in a cirrhotic patient with a peritoneovenous shunt
Author(s) -
Umemura Akira,
Suto Takayuki,
Sasaki Akira,
Fujita Tomohiro,
Endo Fumitaka,
Wakabayashi Go
Publication year - 2015
Publication title -
asian journal of endoscopic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.372
H-Index - 18
eISSN - 1758-5910
pISSN - 1758-5902
DOI - 10.1111/ases.12160
Subject(s) - medicine , peritoneovenous shunt , pneumoperitoneum , surgery , umbilical hernia , shunt (medical) , hernia , ascites , laparoscopy , catheter , hernia repair , anesthesia
Abstract A 62‐year‐old J apanese woman who had developed massive cirrhotic ascites was referred to our hospital for a peritoneovenous shunt implant. However, CT examination revealed an umbilical hernia that had not been observed before the peritoneovenous shunt was implanted. We decided to perform laparoscopic umbilical hernia repair to keep carbon dioxide from flowing backward into the central circulatory system. We first clamped the catheter and set the upper limit of the pneumoperitoneum pressure to 6 mmHg. The central venous pressure was also measured simultaneously. Mesh was then applied over the hernia and fixed by the double‐crown technique. Finally, 1000‐mL physiological saline was infused into the abdominal cavity while the pneumoperitoneum was slowly released. In this case, we safely performed laparoscopic umbilical hernia repair while making some alterations, specifically catheter clamping, reducing pneumoperitoneum pressure, monitoring central venous pressure, and infusing physiological saline.