12. Incisional Hernia Flashcards
Incisional Hernia
- Alternative name
- Definition
- Types
- Etiology
- Clinical picture
- Treatment
Alternative name for Incisional Hernia
Ventral Hernia
Definition of Incisional Hernia
- a hernia that develops at the site of a previous abdominal incision,
- usually within 1 year after the operation
Types of Incisional Hernia
- Cicatricial Incisional Hernia
- Paralytic Incisional Hernia
* Difference between Cicatricial and Paralytic
Pathogenesis of Cicatricial Incisional Hernia in Types of Incisional Hernia
Due to defective closure & muscular defect
Pathogenesis of Paralytic Incisional Hernia in Types of Incisional Hernia
- Direct hernia following appendectomy with muscle cutting incision
- Incisional hernia following Kocher’s incision
- Lumbar hernia following Morris’ incision
Pathogenesis of Direct hernia following appendectomy with muscle cutting incision in Pathogenesis of Paralytic Incisional Hernia in Types of Incisional Hernia
due to injury of the ilioinguinal nerve )> Paralysis of conjoint tendon )> weakens inguinal triangle )> direct hernia
alternative name for Kocher’s incision in Pathogenesis of Paralytic Incisional Hernia in Types of Incisional Hernia
subcostal incision
Pathogenesis of Incisional hernia following Kocher’s incision in Pathogenesis of Paralytic Incisional Hernia in Types of Incisional Hernia
due to damage of intercostal nerves 8, 9 & 10 which are the Nerve supply of muscles of anterior abdominal wall
Alternative name for Morris’ incision in Pathogenesis of Paralytic Incisional Hernia in Types of Incisional Hernia
Lumbar incision
Pathogenesis of Lumbar hernia following Morris’ incision in Pathogenesis of Paralytic Incisional Hernia in Types of Incisional Hernia
due to damage of subcostal nerve.
Difference between Cicatricial and Paralytic in Types of Incisional Hernia
Feeling of a defect on hernia reduction with cicatricial Incisional Hernia
Etiology of Incisional Hernia
A- Preoperative factors
B- Operative factors
C- Post Operative factors
Preoperative factors in Etiology of Incisional Hernia
1- Obesity.
2- Poor health condition
3- Respiratory problems
Poor health condition in Preoperative factors in Etiology of Incisional Hernia
as D.M, cirrhosis, steroid therapy.
Respiratory problems in Preoperative factors in Etiology of Incisional Hernia
Chronic bronchitis or asthma
Operative factors in Etiology of Incisional Hernia
- Muscle cutting incisions instead of muscle splitting incisions.
- Use of absorbable sutures in abdominal closure specially midline
- Insertion of drains though the main wound.
- Injury of nerves (paralytic incisional hernia).
- Rough surgical technique.
Pathogenesis of Use of absorbable sutures in abdominal closure specially midline in Operative factors in Etiology of Incisional Hernia
absorbable sutures are absorbed before healing of the muscle occurs
Post Operative factors in Etiology of Incisional Hernia
- Post operative wound hematoma or infection.
- Poor recovery from anaesthesia.
- Persistent increase of intra-abdominal pressure.
Most common factor in Etiology of Incisional Hernia
Post operative wound hematoma or infection
CLINICAL PICTURE of Incisional Hernia
- Painless swelling with expansile impulse on cough at site of previous operation.
- A defect is detected in the cicatricial type only
TREATMENT of Incisional Hernia
- Surgery is the only line of TTT
* Modalities of repair
Modalities of repair in TREATMENT of Incisional Hernia
1- Hernioplasty
2- Anatomical repair
3- Keel repair
Best modality in Modalities of repair in TREATMENT of Incisional Hernia
Hernioplasty
Principle of Anatomical repair in Modalities of repair in TREATMENT of Incisional Hernia
Each layer is sutured separately.
Keel repair in Modalities of repair in TREATMENT of Incisional Hernia
- Meaning of Keel
- Alternative name
- Principle
- Disadvantages
Meaning of Keel in Keel repair in Modalities of repair in TREATMENT of Incisional Hernia
قاع المركب
Alternative name for Keel repair in Modalities of repair in TREATMENT of Incisional Hernia
Maingot repair
Principle of Keel repair in Modalities of repair in TREATMENT of Incisional Hernia
- The sac is dissected “not opened” & inverted inside the abdomen.
- The defect is closed by a series of interrupted sutures.
Disadvantages of Keel repair in Modalities of repair in TREATMENT of Incisional Hernia
The non obstructive adhesions may become obstructive Leading to intestinal obstruction
