腹腔镜疝修补术（英文版）laparoscopicventralherniarepair.pptVIP

Laparoscopic Hernia Repair:Incisional / Ventral and Inguinal What is a Hernia? DEFECT IN THE FASCIA The fascia is the strength layer surrounding the abdominal cavity A defect in that layer allows intra-abdominal contents (i.e.. fat, intestines) to bulge through the defect. Where Do Hernias Occur? Abdominal Wall At a previous surgical incision At the umbilicus Above the umbilicus (epigastrium) In the inguinal region (groin) Who Requires Treatment? Pain or Discomfort Enlarging Hernias Intestinal Obstruction Nausea, Vomiting, Abdominal Distention Incarceration or Strangulation Hernia Contents are trapped and painful Abdominal Pain and/or a Painful Bulge Blood Supply to trapped contents may be compromised Preoperative Work-up Evaluation by Surgeon Physical Examination CT Scan May or may not be needed At the discretion of the surgeon Surgical Technique Key Components: Reduce the hernia contents “Patch” the defect in the fascia with Mesh Mesh is incorporated into the abdominal wall by the body Reinforces the defect in the fascia Secure the Mesh to the abdominal wall Prevent movement of the mesh prior to incorporation Laparoscopic Ventral Hernia Laparoscopic Inguinal Hernia Complications Bleeding Mesh Infection Injury to Adjacent Organs Recurrence Advantages Decreased Wound Complications Potentially, theorize decrease recurrences; exposes entire undersurface to identify small defects that lead to recurrences Laparoscopic repair can diagnose the “Swiss cheese” hernias Effective modality for recurrent hernias that have been repaired anteriorly (Open) * 10 5 5 5 Laparoscopic Ports Hernia 10 5 Laparoscopic Ports Hernia Hernia 5 Ventral Hernia Defect Mesh Used to Patch Defect Mesh Secured to Abdominal Wall Completed Repair *