HERNIA

HERNIA

HERNIA

DEFINITION

HERNIA

TYPES Primary Incisional

HERNIA

Types – Primary Indirect Direct Femoral Spigelian Epigastric Lumbar: Sup.(Grynfeltt’s): Inf.(Petit’s) Obturator Richter’s Sliding

HERNIA

TYPES Primary Incisional

HERNIA

Types – Incisional Midline Sternotomy Trocar Site Parastomal Lumbar

HERNIA

Incisional Hernias – Etiologic Factors Surgeon

HERNIA Incisional Hernias –Etiologic Factors

Surgeon Infection Tension

Exercise Obesity Ascites Smoking and Chronic Cough

Steroids Malnutrition Advanced Age Diabetes Collagen Disorders

HERNIA

Indications for Repair

HERNIA

Indications for Repair Strangulation Incarceration Local Symptoms Patient Preference Extenuating Circumstances

Travel Insurance Work

HERNIA

Repairs Open

Primary Mesh

Laparoscopic TAPP TEP

HERNIA

Repairs Open

Primary Non-absorbable suture Absorbable suture Separation of components technique

Mesh Laparoscopic

HERNIA

Repairs Open

Primary – Types Bassini McVay Halstead Shouldice Nyhus-Condon

Mesh Laparoscopic

HERNIA

Repairs Open

Primary Mesh – Types

Lichtenstein Plug and Patch Kugel Stoppa

Laparoscopic

HERNIA

Repairs Open

Primary Mesh

Polypropylene ePTFE Dual Composites Biologic

Laparoscopic

HERNIA

Repairs Open

Primary Mesh – Technical Issues

Overlay/Underlay Smooth Seating Fixation

Sutures Tacks Adhesion

Laparoscopic

HERNIA

Repairs Open

Primary – Complications Recurrence Infection Bleeding Nerve Injury Seroma

Mesh Laparoscopic

HERNIA

Recurrent Hernias – Etiologic Factors Surgeon

Missed direct, indirect, or femoral component Inadequate medial closure Inadequate dissection of the sac Inadequate closure of the internal ring

HERNIA

Repairs Open

Primary Mesh – Complications

Recurrence Infection Bleeding Nerve Injury Seroma Adhesions Fistula Bulk

Laparoscopic

HERNIA

Repairs Open

Primary Mesh

Laparoscopic – Complications Recurrence Infection Bleeding Nerve Injury Seroma Adhesions Intestinal Injury Fistula

HERNIA

Potentially Injured Nerves Ilio-inguinal Ilio-hypogastric Genitofemoral Femoral Obturator

HERNIA

Laparoscopic vs. Open Consensus Advantages

Bilateral hernias Recurrences of open repairs Femoral hernias

Debatable Advantages Recurrence rate Comfort Return to normal activities

Negatives Cost to hospital Learning curve

Unknowns Infection rate Chronic pain