title: Laparoscopic umbilical hernia repair in a cirrhotic patient with a peritoneovenous shunt.
abstract: A 62-year-old Japanese 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.
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Umemura
authors.forename: Takayuki
authors.initials: T
authors.lastname: Suto
authors.forename: Akira
authors.initials: A
authors.lastname: Sasaki
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Fujita
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Endo
authors.forename: Go
authors.initials: G
authors.lastname: Wakabayashi
mesh_terms: D001201:Ascites / Q000150:complications / Q000601:surgery; D005260:Female; D006554:Hernia, Umbilical / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D008875:Middle Aged; D010536:Peritoneovenous Shunt
keywords: Laparoscopic surgery; peritoneovenous shunt; umbilical hernia