PMC4066573_01
Intraoperative photograph showing the peritoneum during dissection.
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The peritoneum was very thin and friable on the right and was easily fragmented during the dissection (Fig. 1).
Intraoperative photograph showing placement of the matrix within the abdominal cavity.
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The matrix was then tacked to the abdominal wall in several places superiorly and slightly laterally (using caution to stay medial to the nerves), and Cooper's ligament inferior-medially with 1-cm overlap inferiorly to completely cover the myopectineal orifice (Fig. 2).
Intraoperative photograph showing identification of an incidental femoral hernia upon laparoscopic examination of the left myopectineal orifice. Femoral defect (FD) is shown on the left side. The round ligament (RL), iliac vessels (IV), Cooper's ligament (CL), iliopubic tract (IT), and epigastric vessels (EV) are shown.
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Laparoscopic examination of the left myopectineal orifice identified an incidental femoral hernia (Fig. 3).
Intraoperative photograph showing use of a 10 cm x 4 cm matrix piece for the repair of the inguinal hernia on the patient's left side.
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We decided to use a 10 cm x 4 cm piece of AlloDerm for the repair of the left side with final coverage with peritoneum (Fig. 4).