Wiki Repair of right chest wall hernia, direct

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216
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Greer, SC
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32800? or unlisted 32999?

1. Video thoracoscopy, right
2. Repair of right chest wall hernia, direct
3. Intercostal nerve block

The patient was then repositioned in the left lateral decubitus position with their right side up. The right chest was then prepped and draped in the usual sterile fashion. A surgical time-out was then performed to confirm patient identity, laterality, as well as the surgery to be performed.

Next, an approximately 1cm skin incision was made overlying the 4th interspace in the anterior axillary line. Dissection was carried down through subcutaneous tissues with electrocautery. Lung isolation was verified with anesthesia. The pleural cavity was then entered and video scope inserted. Additional working ports were paced under direct vision. The hemithorax was inspected with findings as described above.

The lung was reflected anteriorly to expose the defect. Two counter incisions were made overlying the defect with a 15 blade scalpel. Dissection was carried down through the subcutaneous tissues with low electrocautery. The latissimus was spared and divided along its fibres in the middle. The serratus was freed from its attachments to the chest wall. Next, the pleura was was freed and delivered back deep to the interspace. Next, a series of interrupted No. 2 vicryl sutures were placed, thereby closing the defect along its course from anterior to posterior. These were secured under direct vision using the videoscope. Next, the 4th-8th interspaces under direct vision were cryo-ablated to -90 degrees centigrade for 90 seconds each in order to affect an intercostal nerve block. A single 24Fr Blake JP drain was placed in the subcutaneous tissues overlying the repair and a single 28 Fr straight chest tube was placed under direct vision. Hemostasis was verified. The lung was re-expanded under direct vision.

The latissimus overlying the hernia site was re-approximated with 0 vicryl. All skin incisions were closed in layers with 0 and 2-0 Vicryl. 4-0 Monocryl in a running subcuticular manner was used to close the skin. Dermabond was placed over the wounds.
 
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