Incisional hernia

HEGAZY SURGERY

1. Under supervision of
Prof. Mohamed Abdel salam

2. An incisional hernia is protrusion of an
organ through the wall in the area of an
old surgical scar.

5. A-straining factors:
1-chronic cough
2-chronic constipation
3-difficulty of micturition(enlarged prostate)
B-General condition:
1-Malnutrition,chronic anaemiaand hypoproteinemia.
2-Obesity and old age.
3-General debilitating diseases:e.gD.M,ureamia, liver
cirrhosis.
4-Prolonged steroid therapy and immunosuppressive
drugs.

6. 1-Anaesthetic causes:
*early extubation
*non relaxation of muscles during closure.
2-Long incision or non anatomical position
3-Poor surgical technique:
*rough surgical manipulation with devtalization
muscles
*inappropriate suture material
*inadequate suturing technique

7. 4-Nerve injury with atrophy of muscles:e.g
ilioinguinal nerve injury during appendectomy.
5-Imperfect hemostasis with hematoma
formation and secondary infection.
6-Inadequate closure or closure under tension.

8. 1-Wound infection: the commonest cause of
recurrence
2-Post operative chest infection or complications
3-Prolonged post operative intestinal obstruction.
4-vomitting
5-Early convalescence
6-Heavy work
7-Pregnancy (abdominal distension)

10. The history of the operation.
The patient may come presented with one of
the following:
A-asymptomatic: the swelling is the main
complain.
B-symptomatic :he come complain with dull
aching pain beside the swelling.
C-with complication:
1-irreducibility. 3-strangulation.
2-Bowl obstruction. 4-Infection.

11. The examination done the patient is standing
and lying flat.
1-inspection (incision, swelling, other
abdominal swelling).
2-palpation( swelling, defect, impluse on
cough, tenderness,……)

12. Done if there is any difficulties in diagnosis.
1-ultra sound.

13. 2-X-ray with contrast ( herniography )
3-CT

15. 1/Losing weight.
2/Strengthening abdominal musclesthrough
regular moderate exercise such as walking.
3/Reducing abdominal pressureby avoiding
constipation.
4/Avoiding undue pressure-Learning to lift heavy
objects in a safe, low-strain way using arm and
leg muscles.
5/Controlling diabetes.
6/Eating a healthy, balanced dietof whole foods.

16. 1-Palliative:-

17. 2-Operations:-Preparation

18. 2-Operations :-
Techniques
1-Simple
apposition
2-Complex
apposition
3-Plastic
fiber mesh
Open Laparoscopic

19. 2-Operations :-
A ) Simple apposition :-

21. B ) Complex apposition ( herniorrhaphy
):-

22. B ) Complex apposition ( herniorrhaphy
):- 1-Keel repair

23. B ) Complex apposition ( herniorrhaphy
):-

24. C ) Plastic fibremesh:-

25. C ) Plastic fibremesh:-

26. C ) Plastic fibremesh:-

28. Used for repair of large incisional hernias .

31. Port placement
Pneumoperitoneum is obtained
An angled laparoscope is inserted to
assess the extent of adhesions and the
defect.
Laparoscopic Technique:-

32. adhesiolysis is performed
It is important to completely expose all
fascial defects
Laparoscopic Technique:-

33. The extent of the fascial defect is clearly
identified. A dual-sided mesh is cut
A 2-0 polypropylene or Gortex suture is then
placed in a horizontal mattress fashion
Skin incisions of 1 mm are made The sutured
are grasped
Laparoscopic Technique:-

34. The sutures are tied with the knots lying
in the subcutaneous tissue
Laparoscopic Technique:-

35. The mesh is additionally secured
The trocars are removed under direct
vision and pneumoperitoneum is released.
Postoperative collections of serum can be
removed by drainage
Laparoscopic Technique:-

36. The patient will be observed in a recovery
area for several hours, for monitoring of body
vitals.
Patients will usually be discharged on the
day of the surgery.if un complicated hernia.
Antibiotics may be prescribed to help prevent
postoperative infection.

37. 1.Fluid buildup at the site of mesh
placement
2.Postoperative bleeding
3.Prolonged suture pain
4.Intestinal injury
5.Nerve injury
6.Fever
7.Intra-abdominal abcess
8.Urinary retention
9.Respiratory distress

38. Done by:-
HebaHamdy1186
HebaRamadan 1187
HebaAdel 1188
HebaAbdel Raouf1189
HebaAbdel Salam 1190