Abdominal Wall Hernia. DefinitionDefinition –External –Interparietal –Internal –Reducible –Non-reducible ( incarcerated) –Strangulated

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Text of Abdominal Wall Hernia. DefinitionDefinition –External...

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  • Abdominal Wall Hernia
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  • DefinitionDefinition External Interparietal Internal Reducible Non-reducible ( incarcerated) Strangulated
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  • Abdominal Wall Hernia Richters herniaRichters hernia Littres herniaLittres hernia
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  • Location GroinGroin UmbilicusUmbilicus Linea alba (epigastric)Linea alba (epigastric) Surgical incisionsSurgical incisions Semi-lunar lineSemi-lunar line DiaphragmDiaphragm Lumbar trianglesLumbar triangles PelvisPelvis
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  • Groin hernia Indirect inguinalIndirect inguinal scrotal Direct inguinalDirect inguinal FemoralFemoral
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  • Groin Hernia Men > womenMen > women Right > leftRight > left 10% of premature babies10% of premature babies 5% of adult population5% of adult population
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  • Indirect Hernia Anatomy Indirect herniaIndirect hernia Dilated persistent processus vaginalis Within spermatic cord Follows indirect course Complete. incomplete sac Sliding hernia Cord lipoma
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  • Direct Hernia Anatomy Hesselbachs triangleHesselbachs triangle Inguinal ligament (base), rectus (medial), inferior epigastric vessels (lateral) Sliding herniaSliding hernia
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  • Femoral hernia
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  • Femoral Hernia Anatomy Inferior to inguinal ligamentInferior to inguinal ligament Women> menWomen> men Usually on medial aspect of femoral sheathUsually on medial aspect of femoral sheath
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  • Diagnosis Groin swelling that resolves with supine positionGroin swelling that resolves with supine position Precipitating factorsPrecipitating factors Increased intra-abdominal pressure Defects in collagen synthesis Smoking Examine erect and supineExamine erect and supine Does not transluminateDoes not transluminate
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  • Groin Hernia Differential Diagnosis HydroceleHydrocele VaricoceleVaricocele EpididymoorchitisEpididymoorchitis Torsion of testisTorsion of testis Undescended testisUndescended testis Ectopic testisEctopic testis Testicular tumorTesticular tumor Femoral artery aneurysmFemoral artery aneurysm LipomaLipoma LymphadenopathyLymphadenopathy
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  • Treatment Expectant managementExpectant management Surgical repairSurgical repair Mesh Open Laparoscopic TEP (totally extra-peritoneal)TEP (totally extra-peritoneal) TAPP (transabdominal pre-peritoneal)TAPP (transabdominal pre-peritoneal)
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  • Complications RecurrenceRecurrence NeuralgiaNeuralgia Ilioinguinal Iliohypogastric Genitofemoral Lateral cutaneous Ischemic orchitisIschemic orchitis Injury to vas deferenceInjury to vas deference Wound infectionWound infection BleedingBleeding
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  • Umbilical Hernia Women> menWomen> men Risk factorsRisk factors ObesityObesity PregnancyPregnancy May rupture with ascitesMay rupture with ascites Repair primarily or with meshRepair primarily or with mesh
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  • Umbilical Hernia Common in infantsCommon in infants Close spontaneously if 2 cm or if persists at age 3-4 years Repair primarily or with meshRepair primarily or with mesh
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  • Epigasteric hernia ....
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  • Epigastric Hernia Incidence 1-5%Incidence 1-5% Men> womenMen> women Pre-peritoneal fat protrusion through decussating fibers at linea albaPre-peritoneal fat protrusion through decussating fibers at linea alba Between xiphoid and umbilicusBetween xiphoid and umbilicus 20% multiple20% multiple Repair primarilyRepair primarily
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  • Incisional Hernia Risk factorsRisk factors Technical Wound infection Smoking Hypoxia/ ischemia Tension Obesity Malnutrition Laparoscopic. open repairLaparoscopic. open repair
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  • Parastomal Hernia Variant of incisional herniaVariant of incisional hernia Paracolostomy > paraileostomyParacolostomy > paraileostomy Low rate if through rectus muscleLow rate if through rectus muscle Traditionally relocate stoma, repair defectTraditionally relocate stoma, repair defect Laparoscopic repairLaparoscopic repair
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  • Parastomal hernia
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  • Spigel hernia ....
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  • Spieghelian Hernia RareRare Hernia through subumbilical portion of semi-lunar lineHernia through subumbilical portion of semi-lunar line Difficult to diagnoseDifficult to diagnose Clinical suspicion (location) CT scan Repair primarily or with meshRepair primarily or with mesh
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  • Lumbar Hernia Congenital, spontaneous or traumaticCongenital, spontaneous or traumatic Grynfeltts triangleGrynfeltts triangle 12 th rib, internal oblique and sacrospinalis muscle Covered by latissimus dorsi Petits trianglePetits triangle Latissimus dorsi, external oblique and iliac crest Covered by superficial fascia
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  • Pelvic Hernia Obturator herniaObturator hernia Most commonly in women Howship-Romberg sign Sciatic herniaSciatic hernia Perineal herniaPerineal hernia
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  • Obteratour hernia
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  • Sciatic hernia
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