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Hernia

Hernia. Abdominal Wall Defect Congenital or acquired Potential for bowel obstruction Incarceration Strangulation May suggest underlying pathology Hepatic disease, BPH, COPD, obstructing colon mass. Pertinent History. Duration/onset Symptoms Local Obstructive

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Hernia

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  1. Hernia • Abdominal Wall Defect • Congenital or acquired • Potential for bowel obstruction • Incarceration • Strangulation • May suggest underlying pathology • Hepatic disease, BPH, COPD, obstructing colon mass

  2. Pertinent History • Duration/onset • Symptoms • Local • Obstructive • Nausea, emesis, pain, distension, obstipation • Prior Incarceration • Related comorbidity • Pulmonary, Constipation, Ascites • Operative risk

  3. Pertinent Exam • Location • Reducible? • Tender? • Skin changes? • Palpable edges, Size? • Genitalia • Rectal

  4. Common Hernias • Umbilical • Ventral • Incisional • Inguinal • Direct, indirect, femoral, obtuator

  5. Bassini repair

  6. Lichtenstein(Amid) hernia repair Nervesand vessels identified Dome

  7. Posterior view of the groin“myopectineal orifice”H. Fruchaud (1956)

  8. Nomenclature in inguinal hernia repairs in adults • Shouldice= 3 layer tissue repair • Bassini repair- term often incorrectly used, specify details! • McVay-Lotheissen= use of suprapubic ligament • “Open mesh repair”- specify! • Lichtenstein= anterior open repair with mesh onlay • Mesh plug- with or without onlay (Rutkow) • Special designs- (Gilbert, Kugel) • TEP = lap. preperitoneal hernioplasty • TAPP= lap. Transabd. preperitoneal hernioplasty • Stoppa repair= Open wrapping of peritoneal sac with mesh, midline approach

  9. onlay – inlay - underlay

  10. Laparoscopic Ventral Hernia

  11. Tension free? More than a fad! • Reduces pain • Reduces recurrences • Reduces overall costs

  12. Umbilical Hernia • Congenital • Most close by age 3 • May remain small and asymptomatic • Can increase with obesity, pregnancy, ascites, peritoneal dialysis • Typical umbilicus

  13. Hernia outcome assessment Past: recurrence, complications, procedure cost Future: acute pain, chronic pain, convalescence time ..chronic herniorraphy pain represents a scientific challenge because the pathogenesis, diagnostic criteria, and therapeutic interventions all have been incompletely evaluated.. H. Kehlet, Hernia, 2002

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