1. Questions: Component Separation
Self Check (Part 5)
Questions: Component Separation
When learner completes the surgery Dr. B asks a few questions, that also show up on the screen with multiple choice answers:] [Correct answers are in bold and underlined.]
Ventral Hernia Repair 1
Component Separation

2. Component Separation Learning Objectives
After completing this section, you will be able to:
State the purpose for using the component separation technique in ventral hernia repair procedures
Select the appropriate surgical instrument and perform each step of component separation
Name the surgical instruments being used in the surgery
Evaluate whether or not additional advancement of component separation is necessary
Suggest two methods of additional advancement
List the steps required to perform each method of component separation additional advancement
[Learning Objectives – as Dr. Beokay states them, they should also appear on the screen]
Voice Over (Dr. Beokay): First, let’s discuss the key learning objectives you should focus on while learning about component separation for this surgery. After performing the component separation yourself, you should be able to:
State the purpose for using the component separation technique in ventral hernia repair procedures
Select the appropriate surgical instrument and perform each step of component separation
Name the surgical instruments being used in the surgery
Evaluate whether or not additional advancement of component separation is necessary
Suggest two methods of additional advancement
List the steps required to perform each method of component separation additional advancement
Ventral Hernia Repair 2
Component Separation

3. Self Check: Question 1
What is the purpose for performing a component separation in ventral hernia procedures?
Select all that apply.
It speeds up the hernia repair surgery
It provides stronger tissues with which to attach the mesh
It enables the rectus abdominal muscles to reach each other so they can be sutured together to cover the defect
Post-surgical abdominal function is maintained – most patients are able to rotate their body after healing
VO Dr. B: What is the purpose for performing a component separation in ventral hernia procedures? Select all that apply.
It speeds up the hernia repair surgery
It provides stronger tissues with which to attach the mesh
It enables the rectus abdominal muscles to reach each other so they can be sutured together to cover the defect
Post-surgical abdominal function is maintained – most patients are able to rotate their body after healing
Ventral Hernia Repair 3
Component Separation

4. Self Check: Question 2
Which surgical instruments are used in the component separation when the external oblique muscle is being separated from the internal oblique muscle? Select all that apply.
Kocher clamps are being used to pull the tissue tautly
Electrocautery is being used to dissect the tissues from each other
A Right-Angle clamp is being used to guide the electrocautery
Surgical scissors are used to snip and separate the tissues from each other
2. VO Dr. B: Which surgical instruments are used in the component separation when the external oblique muscle is being separated from the internal oblique muscle? Select all that apply.
Kocher clamps are being used to pull the tissue tautly
Electrocautery is being used to dissect the tissues from each other
[A Right Angle clamp is being used to guide the electrocautery]
Surgical scissors are used to snip and separate the tissues from each other
Ventral Hernia Repair 4
Component Separation

5. Self Check: Question 3
What are the two methods used for additional advancement of component separation if the two rectus abdominis muscles do not reach each other? Select all that apply.
Posterior Sheath Elevation
Anterior Sheath Elevation
External Oblique Muscle Elevation
Internal Oblique Muscle Elevation
3. VO Dr. B: What are the two methods used for additional advancement of component separation if the two rectus abdominis muscles do not reach each other? Select all that apply.
Posterior Sheath Elevation
Anterior Sheath Elevation
External Oblique Muscle Elevation
Internal Oblique Muscle Elevation
Ventral Hernia Repair 5
Component Separation

6. Self Check: Question 4
When is it necessary to use additional advancement techniques for component separation? Select only one answer.
When about one or two more centimeters will enable the rectus abdominis fasciae to meet comfortably
When the rectus abdominis fasciae meet comfortably
When the external oblique muscle can’t be separated from the internal oblique muscle
When the defect is smaller than one to two centimeters
4. VO Dr. B: When is it necessary to use additional advancement techniques for component separation? Select only one answer.
When about one or two more centimeters will enable the rectus abdominis fasciae to meet comfortably
When the rectus abdominis fasciae meet comfortably
When the external oblique muscle can’t be separated from the internal oblique muscle
When the defect is smaller than one to two centimeters
Ventral Hernia Repair 6
Component Separation

7. Self Check: Question 5
Which procedure provides the most advancement after performing the component separation? Select only one answer.
Separating the external oblique muscle from the abdominal wall
Making an incision in the middle of the rectus abdominis sheath
Separating the anterior sheath from the rectus abdominis muscle laterally
Separate the posterior sheath from the rectus abdominis muscle medially
VO Dr. B: Which procedure provides the most advancement after performing the component separation? Select only one answer.
Separating the external oblique muscle from the abdominal wall
Making an incision in the middle of the rectus abdominis sheath
Separating the anterior sheath from the rectus abdominis muscle laterally
Separate the posterior sheath from the rectus abdominis muscle medially
[Note: Need to determine what should happen in response to correct and incorrect answers]
[Note: End of component separation]
Ventral Hernia Repair 7
Component Separation

8. Self Check: Results [questions component separation]
Ventral Hernia Repair 8
Component Separation

9. Questions: Onlay Position
Self Check (Part 5)
Questions: Onlay Position
When learner completes the procedure Dr. B asks a few questions, that also show up on the screen with multiple choice answers:] [Correct answers are in bold and underlined.]
Ventral Hernia Repair 9
Onlay Position

10. Onlay Position Learning Objectives
After completing this section, you will be able to:
Perform the steps to implant the Strattice® Tissue Matrix using the Onlay (Overlay) position
Identify the appropriate surgical condition in which Strattice® Tissue Matrix can be positioned in the Onlay position
Explain how to prepare the Strattice® Tissue Matrix before proceeding with the implant
Explain how the Strattice® Tissue Matrix will be sutured and to which tissues
Name advantages of using the Onlay position
[Learning Objectives – as Dr. Beokay states them, they should also appear on the screen]
Voice Over (Dr. Beokay): First, let’s discuss the key learning objectives you should focus on while learning how to implant the Strattice® Tissue Matrix in the Onlay position to reinforce the repair. After completing this section, you should be able to:
• Perform the steps to implant the Strattice® Tissue Matrix using the Onlay (Overlay) position
• Identify the appropriate surgical condition in which Strattice® Tissue Matrix can be positioned in the Onlay position
• Explain how to prepare the Strattice® Tissue Matrix before proceeding with the implant
• Explain how the Strattice® Tissue Matrix will be sutured and to which tissues
• Name advantages of using the Onlay position
Ventral Hernia Repair 10
Onlay Position

11. Self Check: Question 1
What is the other term to used to describe implantation of the Strattice® Tissue Matrix in the Onlay position? Select only one answer.
Underlay
Inlay
Sublay
Overlay
[Learner begins the Onlay procedure. When learner completes the surgery Dr. B asks a few questions, that also show up on the screen with multiple choice answers:] [Correct answers are in bold and underlined .]
1. VO Dr. B: What is the other term to used to describe implantation of the Strattice® Tissue Matrix in the Onlay position? Select only one answer.
Underlay
Inlay
Sublay
Overlay
Ventral Hernia Repair 11
Onlay Position

12. Self Check: Question 2
Which surgical condition is necessary in order to place the Strattice® Tissue Matrix in the onlay position? Select only one answer.
Before the rectus abdominis fasciae has been closed with sutures
After the rectus abdominis fasciae has been closed with sutures
When the hernia defect is so large, that the rectus abdominis fasciae cannot be sutured together
Only if the patient has an infection around the site of the hernia
2. VO Dr. B: Which surgical condition is necessary in order to place the Strattice® Tissue Matrix in the onlay position? Select only one answer.
Before the rectus abdominis fasciae has been closed with sutures
After the rectus abdominis fasciae has been closed with sutures
When the hernia defect is so large, that the rectus abdominis fasciae cannot be sutured together
Only if the patient has an infection around the site of the hernia
Ventral Hernia Repair 12
Onlay Position

13. Self Check: Question 3
Which statements are true when preparing Strattice® Tissue Matrix for implantation?
Select all that apply.
The mesh must soak in either sterile saline solution or sterile Lactated Ringer’s solution prior to implantation
The mesh must soak in either sterile saline solution or dextrose 5% solution prior to implantation
The mesh must soak in the solution at room temperature for 4 hours prior to implantation
The mesh must soak in the solution at room temperature for 2 minutes prior to implantation
VO Dr. B: Which statements are true when preparing Strattice® Tissue Matrix for implantation? Select all that apply.
The mesh must soak in either sterile saline solution or sterile Lactated Ringer’s solution prior to implantation
The mesh must soak in either sterile saline solution or dextrose 5% solution prior to implantation
The mesh must soak in the solution at room temperature for 4 hours prior to implantation
The mesh must soak in the solution at room temperature for 2 minutes prior to implantation
Ventral Hernia Repair 13
Onlay Position

14. Self Check: Question 4
What is the purpose of using quilting stitches after the Strattice® Tissue Matrix has been sutured on the sides, top and bottom?
Select all that apply.
The quilting stitches secure the mesh to the rectus abdominis fascia, thereby reducing tension on the closure
It is less likely that fluid that gets between the mesh and the rectus abdominis fasciae will lift the mesh upwards
Fewer stitches on the sides are needed
The risk of infection is reduced
VO Dr. B: What is the purpose of using quilting stitches after the Strattice® Tissue Matrix has been sutured on the sides, top and bottom? Select all that apply.
The quilting stitches secure the mesh to the rectus abdominis fascia, thereby reducing tension on the closure
It is less likely that fluid that gets between the mesh and the rectus abdominis fasciae will lift the mesh upwards
Fewer stitches on the sides are needed
The risk of infection is reduced
Ventral Hernia Repair 14
Onlay Position

15. Self Check: Question 5
Sometimes a mesh is not used in hernia repair. Which of the following are advantages for using a mesh in repairing hernias? Select all that apply.
The mesh provides added support of the closure, thereby helping to reduce tension on the sutures holding the fasciae together
The mesh reinforces the weakness that was created when the external oblique fascia were divided
The risk of incisional hernia recurrence secondary to hernia surgery may be reduced
The implanted mesh may enhance the function of the external oblique muscles on both sides by pulling the muscles toward the midline
VO Dr. B: Sometimes a mesh is not used in hernia repair. Which of the following are advantages for using a mesh in repairing hernias? Select all that apply.
The mesh provides added support of the closure, thereby helping to reduce tension on the sutures holding the fasciae together
The mesh reinforces the weakness that was created when the external oblique fascia were divided
The risk of incisional hernia recurrence secondary to hernia surgery may be reduced
The implanted mesh may enhance the function of the external oblique muscles on both sides by pulling the muscles toward the midline
[Note: Need to determine what should happen in response to correct and incorrect answers]
[Note: End of Onlay procedure]
Ventral Hernia Repair 15
Onlay Position

16. Self Check: Results [onlay procedure]
Ventral Hernia Repair 16
Onlay Position

17. Questions: Retrorectus Underlay Procedure
Self Check (Part 5)
Questions: Retrorectus Underlay Procedure
When learner completes the surgery Dr. B asks a few questions, that also show up on the screen with multiple choice answers:] [Correct answers are in bold and underlined.]
Ventral Hernia Repair 17
Retrorectus Underlay/Sublay Position

18. Retrorectus Underlay/Sublay Position Learning Objectives
After completing this section, you will be able to:
Perform the steps to implant the Strattice® Tissue Matrix using the retrorectus underlay (sublay) position
Identify the appropriate surgical condition in which Strattice® Tissue Matrix can be positioned in the retrorectus underlay position
Identify the two types of sutures that can be used when stitching the mesh laterally to the anterior rectus sheath
Name the advantage of implanting the Strattice® Tissue Matrix the retrorectus underlay position
[Learning Objectives – as Dr. Beokay states them, they should also appear on the screen]
Voice Over (Dr. Beokay): First, let’s discuss the key learning objectives you should focus on while learning how to implant the Strattice® Tissue Matrix in the retrorectus underlay (sublay) position to reinforce the repair. After completing this section, you should be able to:
• Perform the steps to implant the Strattice® Tissue Matrix using the retrorectus underlay position
• Identify the appropriate surgical condition in which Strattice® Tissue Matrix can be positioned in the retrorectus underlay position
• Identify the two types of sutures that can be used when stitching the mesh laterally to the anterior rectus sheath
• Name the advantage of implanting the Strattice® Tissue Matrix the retrorectus underlay position
Ventral Hernia Repair 18
Onlay Position

19. Self Check: Question 1: Retrorectus Underlay Procedure
What is the other term to used to describe implantation of the Strattice® Tissue Matrix in the underlay position? Select only one answer.
Onlay
Inlay
Sublay
Overlay
[Learner begins the retrorectus underlay procedure. When learner completes the surgery Dr. B asks a few questions, that also show up on the screen with multiple choice answers:] [Correct answers are in bold and underlined .]
1. VO Dr. B: What is the other term to used to describe implantation of the Strattice® Tissue Matrix in the underlay position? Select only one answer.
Onlay
Inlay
Sublay
Overlay
Ventral Hernia Repair 19
Retrorectus Underlay/Sublay Position

20. Self Check: Question 2: Retrorectus Underlay Procedure
Which surgical condition is necessary in order to place the Strattice® Tissue Matrix in the retrorectus underlay position? Select all that apply.
After the rectus abdominis fasciae has been closed with sutures
When the hernia defect is so large, that the rectus abdominis fasciae cannot be sutured together
When the rectus fasciae meet comfortably at the midline
Before the rectus abdominis fasciae has been closed with sutures
2. VO Dr. B: Which surgical condition is necessary in order to place the Strattice® Tissue Matrix in the retrorectus underlay position? Select only one answer.
After the rectus abdominis fasciae has been closed with sutures
When the hernia defect is so large, that the rectus abdominis fasciae cannot be sutured together
When the rectus fasciae meet comfortably at the midline
Before the rectus abdominis fasciae has been closed with sutures
Ventral Hernia Repair 20
Retrorectus Underlay/Sublay Position

21. Self Check: Question 3: Retrorectus Underlay Procedure
What two types of sutures can be used when stitching the mesh laterally to the anterior rectus sheath? Select all that apply.
Apex suture
Quilting suture
Running horizontal mattress suture
Interrupted figure of eight suture
VO Dr. B: What two types of sutures can be used when stitching the mesh laterally to the anterior rectus sheath?
Select all that apply.
Apex suture
Quilting suture
Running horizontal mattress suture
Interrupted figure of eight suture
Ventral Hernia Repair 21
Retrorectus Underlay/Sublay Position

22. Self Check: Question 4: Retrorectus Underlay Procedure
What is the advantage of using the retrorectus underlay position for implanting the mesh in repairing hernias? Select one answer.
The procedure takes less time because there is less suturing involved
Less mesh is required
There’s an additional layer of closure : the mesh can be positioned between the sutured posterior retrorectus fasciae and the sutured anterior rectus sheath
There’s less chance of infection
VO Dr. B: What is the advantage of using the retrorectus underlay position for implanting the mesh in repairing hernias? Select one answer.
The procedure takes less time because there is less suturing involved
Less mesh is required
There’s an additional layer of closure : the mesh can be positioned between the sutured posterior retrorectus fasciae and the sutured anterior rectus sheath
There’s less chance of infection
[Note: Need to determine what should happen in response to correct and incorrect answers]
[Note: End of retrorectus underlay procedure]
Ventral Hernia Repair 22
Retrorectus Underlay/Sublay Position

23. Self Check: Results [Retrorectus Underlay Procedure ]
Ventral Hernia Repair 23
Onlay Position

24. Self Check (Part 5)
Questions: Underlay Technique in the Intraperitoneal Position Procedure
When learner completes the surgery Dr. B asks a few questions, that also shows up on the screen with multiple choice answers:] [Correct answers are in bold and underlined.]
Ventral Hernia Repair 24
Strattice® Underlay Technique in the Intraperitoneal Position

25. Underlay Technique in the Intraperitoneal Position Learning Objectives
After completing this section, you will be able to:
Perform the steps to implant the Strattice® Tissue Matrix using the underlay procedure in the intraperitoneal position
Identify the appropriate surgical condition in which Strattice® Tissue Matrix would be implanted using the underlay technique in the intraperitoneal position
State the number of centimeters the edges of the abdominis muscles should overlap with the mesh
Calculate the size of the mesh to be measured, given the width of the defect
Identify the two types of suture techniques that can be used when securing the mesh as a bridge in the intraperitoneal position
[Learning Objectives – as Dr. Beokay states them, they should also appear on the screen]
Voice Over (Dr. Beokay): First, let’s discuss the key learning objectives you should focus on while learning how to implant the Strattice® Tissue Matrix in the retrorectus underlay (sublay) position to reinforce the repair. After completing this section, you should be able to:
Perform the steps to implant the Strattice® Tissue Matrix using the underlay procedure in the intraperitoneal position
Identify the appropriate surgical condition in which Strattice® Tissue Matrix would be implanted using the underlay technique in the intraperitoneal position
State the number of centimeters the mesh should overlap with the edges of the abdominis muscles
Calculate the size of the mesh to be measured, given the width of the defect.
Identify the two types of sutures can be used when securing the mesh as a bridge in the intraperitoneal position
Ventral Hernia Repair 25
Strattice® Underlay Technique in the Intraperitoneal Position

26. Self Check: Question 1: Underlay Technique in the
Self Check: Question 1: Underlay Technique in the Intraperitoneal Position Procedure
When would it be necessary to perform a ventral hernia surgery using the underlay technique in the intraperitoneal position? Select only one answer.
When the rectus abdominis muscles meet comfortably at the midline
After the rectus abdominis muscles have been sutured together
When the rectus abdominis muscles don’t meet comfortably at the midline
When the defect is small
[Learner begins the underlay intraperitoneal procedure. When learner completes the surgery Dr. B asks a few questions, that also show up on the screen with multiple choice answers:] [Correct answers are in bold and underlined .]
1. VO Dr. B: When would it be necessary to perform a ventral hernia surgery using the underlay technique in the intraperitoneal position? Select only one answer.
When the rectus abdominis muscles meet comfortably at the midline
After the rectus abdominis muscles have been sutured together
When the rectus abdominis muscles don’t meet comfortably at the midline
When the defect is small
Ventral Hernia Repair 26
Strattice® Underlay Technique in the Intraperitoneal Position

27. Self Check: Question 2: Underlay Technique in the
Self Check: Question 2: Underlay Technique in the Intraperitoneal Position Procedure
How many centimeters (cm) should the edges of the rectus abdominis muscles overlap with the Strattice® mesh? Select only one answer.
1-2 cm
3-5 cm
6-10 cm
More than 10 cm
[Learner begins the underlay intraperitoneal procedure. When learner completes the surgery Dr. B asks a few questions, that also show up on the screen with multiple choice answers:] [Correct answers are in bold and underlined .]
2. VO Dr. B: How many centimeters (cm) should the edges of the rectus abdominis muscles overlap with the Strattice® mesh? Select only one answer.
1-2 cm
3-5 cm
16-20 cm
More than 10 cm
Ventral Hernia Repair 27
Strattice® Underlay Technique in the Intraperitoneal Position

28. Self Check: Question 3: Underlay Technique in the
Self Check: Question 3: Underlay Technique in the Intraperitoneal Position Procedure
How wide should the Strattice® mesh be cut if the size of the defect is 10 cm wide? Select only one answer.
10 cm
13-15 cm
16-20 cm
30-50 cm
[Learner begins the underlay intraperitoneal procedure. When learner completes the surgery Dr. B asks a few questions, that also show up on the screen with multiple choice answers:] [Correct answers are in bold and underlined .]
3. VO Dr. B: How wide should the Strattice® mesh be cut if the size of the defect is 10 cm wide? Select only one answer.
10 cm
13-15 cm
16-20 cm
30-50 cm
Ventral Hernia Repair 28
Strattice® Underlay Technique in the Intraperitoneal Position

29. Self Check: Question 4: Underlay Technique in the
Self Check: Question 4: Underlay Technique in the Intraperitoneal Position Procedure
Which of the following statements is/are true when implanting the mesh in the underlay intraperitoneal position? Select all that apply.
The mesh can be implanted using interrupted figure-of-eight sutures all around or with running horizontal mattress sutures laterally
The mesh lays flush against the peritoneum
The mesh is positioned between the posterior retrorectus fascia and the anterior rectus sheath
The mesh can act as a bridge if the rectus abdominal muscles don’t meet each other comfortably at the midline
[Learner begins the underlay intraperitoneal procedure. When learner completes the surgery Dr. B asks a few questions, that also show up on the screen with multiple choice answers:] [Correct answers are in bold and underlined .]
4. VO Dr. B: Which of the following statements is/are true when implanting the mesh in the underlay intraperitoneal position? Select all that apply.
The mesh can be implanted using interrupted figure-of-eight sutures all around or with running horizontal mattress sutures laterally
The mesh lays flush against the peritoneum
The mesh is positioned between the posterior retrorectus fascia and the anterior rectus sheath
The mesh can act as a bridge if the rectus abdominal muscles don’t meet each other comfortably at the midline
Ventral Hernia Repair 29
Strattice® Underlay Technique in the Intraperitoneal Position

30. Self Check: Results [Underlay Technique in the
Self Check: Results [Underlay Technique in the Intraperitoneal Position Procedure]
Ventral Hernia Repair 30
Strattice® Underlay Technique in the Intraperitoneal Position