医药卫生切口疝课件.ppt

Classification and surgical treatmentof incisional hernia Results of an experts’ meeting Introduction the optimum surgical treatment of incisional hernia is still an answered problem a standardised access to incisional hernia therapy is still lacking The choice of surgical technique is mainly based on the individual surgeon’s preference and the financial background of the hospital respect to the development of evidence-based surgical practice and practice guidelines Methods In preparation of the “20th International Congress of the European Hernia Society” – GREPA – it was decided to carry out an experts’meeting concerning the current questions of incisional hernia surgery. Ten well-known international experts were nominated by the scientific committee of the GREPA. Three months before the congress, the chosen experts were provided with a prepared plan of the discussion and an overview of the literature. Results Question 1: The definition of the incisional hernia Any abdominal wall gap with or without bulge in the area of a postoperative scar perceptible or palpable by clinical examination or imaging”. Question 2: The classification of incisional hernias Incisional hernias can be classified according to their localisation, size, recurrence, reducibility and symptoms. According to localisation 1. Vertical 1.1. Midline above or below umbilicus 1.2. Midline including umbilicus right or left 1.3. Paramedian right or left 2. Transversal 2.1. Above or below umbilicus right or left 2.2. Crossed midline or not 3. Oblique 3.1. Above or below umbilicus right or left 4. Combined (midline + oblique; midline + parastomal;etc) According to size 1. Small (5 cm in width or length) 2. Medium (5–10 cm in width or length) 3. Large (10 cm in width or length) differentiate between the “false” and the “real” fascial gap The “false” fascial gap is the defect of the scar-tissue that embraces the frontal abdominal wall, which does not include muscular apo