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    Abdominal: Al Hernia

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    Von Hippo
    An incisional hernia occurs in 10-15% of patients with a prior abdominal incision and results from a breakdown of the fasciae closure. The most critical information about an incisional hernia includes its location on the abdominal wall and size. The European Hernia Society classification divides the abdomen into medial and lateral zones and further subdivides the zones. Treatment depends on whether the hernia is asymptomatic, reducible, incarcerated, or strangulated. Surgical repair is recommended and can be done with primary tissue repair or mesh repair, open or laparoscopically. Obesity, diabetes, and smoking increase risk of complications.

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    Abdominal: Al Hernia

    Uploaded by

    Von Hippo
    104 views3 pages
    An incisional hernia occurs in 10-15% of patients with a prior abdominal incision and results from a breakdown of the fasciae closure. The most critical information about an incisional hernia includes its location on the abdominal wall and size. The European Hernia Society classification divides the abdomen into medial and lateral zones and further subdivides the zones. Treatment depends on whether the hernia is asymptomatic, reducible, incarcerated, or strangulated. Surgical repair is recommended and can be done with primary tissue repair or mesh repair, open or laparoscopically. Obesity, diabetes, and smoking increase risk of complications.

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    Original Title

    HERNIA

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    An incisional hernia occurs in 10-15% of patients with a prior abdominal incision and results from a breakdown of the fasciae closure. The most critical information about an incisional hernia includes its location on the abdominal wall and size. The European Hernia Society classification divides the abdomen into medial and lateral zones and further subdivides the zones. Treatment depends on whether the hernia is asymptomatic, reducible, incarcerated, or strangulated. Surgical repair is recommended and can be done with primary tissue repair or mesh repair, open or laparoscopically. Obesity, diabetes, and smoking increase risk of complications.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    104 views3 pages

    Abdominal: Al Hernia

    Uploaded by

    Von Hippo
    An incisional hernia occurs in 10-15% of patients with a prior abdominal incision and results from a breakdown of the fasciae closure. The most critical information about an incisional hernia includes its location on the abdominal wall and size. The European Hernia Society classification divides the abdomen into medial and lateral zones and further subdivides the zones. Treatment depends on whether the hernia is asymptomatic, reducible, incarcerated, or strangulated. Surgical repair is recommended and can be done with primary tissue repair or mesh repair, open or laparoscopically. Obesity, diabetes, and smoking increase risk of complications.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    INCISIONAL

    HERNIA
    ABDOMINAL WALL

    INCISION AL HERNIA
    °

    10% to 15%0 PATIENTS WITH A PRIOR ABDOMINAL INCISION


    °
    MIDLINE INCISIONS 20% WILL DEVELOP HERNIA EVENTUALLY
    -

    °
    VERTICAL INCISIONS 1 TRANSVERSE OR OBLIQUE INCISIONS
    °

    UPPER ABDOMINAL INCISIONS I LOWER INCISIONS


    °
    RESULT FROM A BREAKDOWN OF THE FASCIAE CLOSURE
    °

    CAN DEVELOP UP TO TO YEARS AFTER SURGERY BUT NORMALLY


    OCCUR IN THE EARLY POSTOPERATIVE PERIOD
    °

    CAN PRESENT AS ASYMPTOMATIC BULGES OR WITH SEVERE DISCOMFORT

    RISK FACTORS :
    °
    PATIENT FACTORS
    ✓ OLD AGE
    ✓COMORBID CONDITIONS ( DIABETES EMPHYSEMA SLEEP APNEA)
    , .

    ✓ OBESITY MOST IMPORTANT PATIENT FACTOR


    -

    ↳ ASSOCIATED E INCARCERATION 8 RECURRENCES


    ↳ BMI 33kg Im OR CLASS I OBESITY ( WITH
    '

    ✓ SMOKING

    MALNUTRITION
    ✓

    IMMUNOSUPPRESSIVE THERAPY
    V

    ✓
    CONNECTIVE TISSUE DISORDER
    •
    TECHNICAL FACTORS
    ✓
    WOUND INFECTION 25% WILL DEVELOP INCISION AL HERNIA
    -

    ✓ SUBOPTIMAL FASCIAE CLOSURE


    ↳ EXCESS WOUND TENSION
    ↳NOT ACHIEVING A SUTURE TO WOUND LENGTH RATIO OF ¥4 : I
    ✓ ABDOMINAL FASCIAL DEHISCENCE
    BROKEN SUTURES OR LOSS OF INTEGRITY OF ABDOMINAL FRUA
    -

    ✓
    TYPE OF ABDOMINAL SURGERY
    "

    CLASSIFICATION
    •
    EUROPEAN HERNIA SOCIETY ( EHS) CLASSIFICATION
    ↳ ASSESS HERNIA WIDAT 4 LOCATION TO GATHER DATA ON RECURRENCE RISK

    MMM ④
    •
    VENTRAL HERNIA WORKING GROUP GRADING SCALE
    ↳ USES COMORBID MFS & WOUND CLASS TO PREDICT e- LONG TERM RECURRENCE RISK

    •
    ACCD6. TO HERNIA SIZE
    G L4cm 4 to 10cm AND I10cm ( COMPLEX HERNIA)
    , ,

    •
    CLINICAL CLASSIFICATION
    ↳ ASYMPTOMATIC REDUCIBLE INCARCERATED OR STRANGULATED
    , .

    THE MOST CRITICAL ANATOMICAL INFN ABOUT AN INCISIONAL HERNIA IS 1B LOCAMON ON e- ABDOMINAL WALL4 ITS SIZE THE .

    EUROPEAN HERNIA SOCIETY (Elt) CLASSIFICATION FOR INCISIONAL ABDOMINAL WALL HERNIA DIVIDES E ABDOMEN INTO
    A MEDIAL ZONE & A LATERAL ZONE THE MEDIAL ZONE DEFINED Its MEDIAL TO THE LATERAL MARGIN 0 ERECTUS
    .

    SHEATH IS SUBDIVIDED INTO 5 SUBONES ( XIPHOID EPIGASTRIC UMBILICAL INFRAUMBILICAL & SUPRAPUBIC) THE LATERAL
    , , , .

    ZONE IS SUBDIVIDED INTO FOUR SUB ZONES (SUBCOSTAL FLANK lU Al 4 LUMBAR) , ,

    DIAGNOSIS
    °
    HISTORY & PHYSICAL EXAMINATION
    •
    IMAGING
    ↳ CT SCAN
    ↳ OBESE

    ↳ PREOPERATIVE EVALUATION OF COMPLEX HERNIA


    ↳ COMPLEX HERNIA I 10cm WIDTH NOR
    -

    SIGNIFICANT LOSS E DOMAIN I 20 -30%


    E E VISCERA RESIDING OUTSIDE e- ABDOMINAL
    CAVITY E HERNIA site
    ↳ MORPHOLOGY
    ↳ CONTENTS
    ↳ QUALITY E ABDOMINAL MUSOUEA TUNE

    MANAGEMENT → RELATIVE CONMA INDICATIONS


    ,
    •
    ASSESSMENT E E CLINICAL CONDITION O E PATIENT i
    G SMOKIN 6
    •
    ASYMPTOMATIC VS SYMPTOM ATL.

    i →
    INCREASE MSKO SSI V
    G ACUTELY INCARCERATED/ STRANGULATED i REMANENCE
    ↳ REDUCIBLE/CHRONICALLY INCARCERATED "
    → MIN 4 8 WIG SMOKING
    -

    •
    EMINEM US EhEUNESUhbEM# RECOMMENDED FOR SYMPTOMATIC
    .
    PANTINB CESSATION
    ↳ OBJECTIVE : TO AWE VIATE ANY ACUTE PROBLEMS (BOWEL ISCHEMIA OBSTRUCTION ABDOMINAL PAIN)
    , ,

    •
    OBESITY
    ↳ LONGER HOSPITAL STAY 551 RECURRENCE READMISSIONS
    , , ,

    ↳ REPAIR IS NOT RECOMMENDED IN PB I BMI I 50kg / m2


    .

    •
    DIABETES
    ↳ WELL KNOWN RISK for POST OP COMPLICATIONS
    M Arm ⑤
    TREATMENT is HIGHER KATEE INFECTIONS
    i ' STANDARD TORELEUTVEMNGMTOINCISIONAL HERNIAS
    •
    SURGICAL TREATMENT "
    -

    ↳ PRIMARY TISSUE REPAIR US MESH REPAIR) > LARGE DEFECT 14cm


    .
    -

    ↳ OPEN VI. LAPAROSCOPY ↳ REDUCED RECURRENCE RATE 1341504


    ↳ COMPONENT SEPARATION TECHNIQUE ↳ SYNTHETIC VS.tl/OLO&-7MADEFR0M0n6AN1CBl0MATENAL(P0NlNt-
    # Dennis .

    I
    FUSED f
    NEARLY EXCLUSIVELY FORREPAIRO LARGE OVERLAY IONLAY
    SMALL INTESTINE SUBMUCOSA BOVINE DERMIS
    ,

    oneericanrnum Dennison FASCIA


    ,

    ( 110cm) OR COMPLEX MIDLINE ABDOMINAL WALL INTERLAY ( INLAY LATAOACADAVEMCMLMAN)

    DEFEAT →
    SUBWAY
    ↳ ADVANTAGE ORFSTONNG ABDOMINAL WALL FUNCTION UNDERLAY 11PM
    ↳ OPEN OR LAPAROSCOPIC APPROACH ↳ INTRA PERITONEAL ONLAYMESH
    -

    MMM

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