Abdominal Wall Hernia - Stritch School of Medicine：腹壁疝- Stritch医学.ppt

Abdominal Wall Hernia Sharfi Sarker, MD December 5, 2006 Abdominal Wall Hernia Definition External Interparietal Internal Reducible Non-reducible (aka incarcerated) Strangulated Abdominal Wall Hernia Richter’s hernia Littre’s hernia Location Groin Umbilicus Linea alba (epigastric) Surgical incisions Semi-lunar line Diaphragm Lumbar triangles Pelvis Groin hernia Indirect inguinal scrotal Direct inguinal Femoral Groin Hernia Men women Right left 10% of premature babies 5% of adult population Indirect Hernia Anatomy Indirect hernia Dilated persistent processus vaginalis Within spermatic cord Follows indirect course Complete vs. incomplete sac Sliding hernia Cord lipoma Direct Hernia Anatomy Hesselbach’s triangle Inguinal ligament (base), rectus (medial), inferior epigastric vessels (lateral) Sliding hernia Femoral Hernia Anatomy Inferior to inguinal ligament Women men Cloquet’s node Usually on medial aspect of femoral sheath Diagnosis Groin swelling that resolves with supine position Precipitating factors Increased intra-abdominal pressure Defects in collagen synthesis Smoking Examine erect and supine Does not transilluminate Groin Hernia Differential Diagnosis Hydrocele Varicocele Epididymoorchitis Torsion of testis Undescended testis Ectopic testis Testicular tumor Femoral artery aneurysm Lipoma Lymphadenopathy Treatment Expectant management Surgical repair Mesh Open Laparoscopic TEP (totally extra-peritoneal) TAPP (transabdominal pre-peritoneal) Complications Recurrence Neuralgia Ilioinguinal Iliohypogastric Genitofemoral Lateral cutaneous Ischemic orchitis Injury to vas deference Wound infection Bleeding Umbilical Hernia Women men Risk factors Obesity Pregnancy May rupture with ascites Repair primarily or with mesh Umbilical Hernia Common in infants Close spontaneously if 1.5 cm Repair if 2 cm or if persists at age 3-4 years Repair primarily or with mesh Epigastric Hernia Incidence 1-5% Men women Pre-peritoneal fat protrusion through decussatin