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Abdominal Wall Hernia

Abdominal Wall Hernia. P. Marco Fisichella, MD Assistant Professor Department of Surgery. Abdominal Wall Hernia. Definition External Interparietal Internal Reducible Non-reducible (aka incarcerated) Strangulated. Abdominal Wall Hernia. Richter’s hernia Littre’s hernia. Location.

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Abdominal Wall Hernia

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  1. Abdominal Wall Hernia P. Marco Fisichella, MD Assistant Professor Department of Surgery

  2. Abdominal Wall Hernia • Definition • External • Interparietal • Internal • Reducible • Non-reducible (aka incarcerated) • Strangulated

  3. Abdominal Wall Hernia • Richter’s hernia • Littre’s hernia

  4. Location • Groin • Umbilicus • Linea alba (epigastric) • Surgical incisions • Semi-lunar line • Diaphragm • Lumbar triangles • Pelvis

  5. Groin hernia • Indirect inguinal • scrotal • Direct inguinal • Femoral

  6. Groin Hernia • Men > women • Right > left • 10% of premature babies • 5% of adult population

  7. Indirect Hernia Anatomy • Indirect hernia • Dilated persistent processus vaginalis • Within spermatic cord • Follows indirect course • Complete vs. incomplete sac • Sliding hernia • Cord lipoma

  8. Direct Hernia Anatomy • Hesselbach’s triangle • Inguinal ligament (base), rectus (medial), inferior epigastric vessels (lateral) • Sliding hernia

  9. Femoral Hernia Anatomy • Inferior to inguinal ligament • Women> men • Cloquet’s node • Usually on medial aspect of femoral sheath

  10. Diagnosis • Groin swelling that resolves with supine position • Precipitating factors • Increased intra-abdominal pressure • Defects in collagen synthesis • Smoking • Examine erect and supine • Does not transilluminate

  11. Hydrocele Varicocele Epididymoorchitis Torsion of testis Undescended testis Ectopic testis Testicular tumor Femoral artery aneurysm Lipoma Lymphadenopathy Groin Hernia Differential Diagnosis

  12. Treatment • Expectant management • Surgical repair • Mesh • Open • Laparoscopic • TEP (totally extra-peritoneal) • TAPP (transabdominal pre-peritoneal)

  13. Complications • Recurrence • Neuralgia • Ilioinguinal • Iliohypogastric • Genitofemoral • Lateral cutaneous • Ischemic orchitis • Injury to vas deference • Wound infection • Bleeding

  14. Umbilical Hernia • Women> men • Risk factors • Obesity • Pregnancy • May rupture with ascites • Repair primarily or with mesh

  15. Umbilical Hernia • Common in infants • Close spontaneously if <1.5 cm • Repair if > 2 cm or if persists at age 3-4 years • Repair primarily or with mesh

  16. Epigastric Hernia • Incidence 1-5% • Men> women • Pre-peritoneal fat protrusion through decussating fibers at linea alba • Between xiphoid and umbilicus • 20% multiple • Repair primarily

  17. Incisional Hernia • Risk factors • Technical • Wound infection • Smoking • Hypoxia/ ischemia • Tension • Obesity • Malnutrition • Laparoscopic vs. open repair

  18. Parastomal Hernia • Variant of incisional hernia • Paracolostomy > paraileostomy • Low rate if through rectus muscle • Traditionally relocate stoma, repair defect • Concern for mesh erosion • Laparoscopic repair

  19. Spieghelian Hernia • Rare • Hernia through subumbilical portion of semi-lunar line • Difficult to diagnose • Clinical suspicion (location) • CT scan • Repair primarily or with mesh

  20. Lumbar Hernia • Congenital, spontaneous or traumatic • Grynfeltt’s triangle • 12th rib, internal oblique and sacrospinalis muscle • Covered by latissimus dorsi • Petit’s triangle • Latissimus dorsi, external oblique and iliac crest • Covered by superficial fascia

  21. Pelvic Hernia • Obturator hernia • Most commonly in women • Howship-Romberg sign • Sciatic hernia • Perineal hernia

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