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Mark W. Clemens, MD • Houston, Texas
Ventral hernia repair using SERI® Surgical Scaffold for soft tissue support
Operative technique
The surgical plan for this patient included an ileal conduit construction with urostomy and an abdominal wall reconstruction with bilateral component separation. SERI® Surgical Scaffold was used to provide abdominal soft tissue support. Creating a stoma would classify this case as a Grade 3 wound.1
Step 1: The patient had a 10-cm-wide and 22-cm-long intraoperative defect [Figure 1]. Dr. Clemens used bilateral component separations to bring the rectus complexes to the midline [Figure 2].
Step 2: Next, the posterior rectus sheath was separated from the rectus abdominis muscle, and then closed on the midline to create a retrorectus plane [Figure 3]. Closure of the posterior rectus sheath prior to placement of SERI® Surgical Scaffold is an important step to avoid direct contact with the bowel.2
Step 3: A 10-cm x 25-cm sheet of SERI® Surgical Scaffold was inset in the retrorectus plane to provide abdominal soft tissue support [Figure 4].
Figure 1. Intraoperative defect: 10 cm wide, 22 cm long
Figure 2. Component separation and release of the external oblique fascia with preservation of the periumbilical skin perforators
Figure 3. Closure of the posterior fascia and creation of a retrorectus plane
Figure 4. SERI® Surgical Scaffold inset in the retrorectus plane
Figure 5. Placement of drains, closure of the skin, and with visible stoma
Step 4: SERI® Surgical Scaffold was tacked into place with nonabsorbable #1 Prolene® U-stitches that were placed on hemostats and then tied sequentially. The fascia was then closed at the midline using nonabsorbable #1 Prolene® figure-of-8 sutures followed by a running suture.
Step 5: 2-0 PDS was used to place quilting sutures and to close Scarpa’s fascia. Three drains were placed subcutaneously [Figure 5].
Step 6: The skin was closed with 3-0 Monocryl® dermal sutures and 4-0 Monocryl® subcuticular sutures.
This Case Review is provided for your information only. As with other surgical and medical decisions, it is the responsibility of surgeons to use sound medical judgment in utilizing the procedures best suited to the needs of each patient and to the skills and experiences of the surgeon. Please refer to the SERI® Surgical Scaffold Instructions for Use for current information.