logging in or signing up incisional hernia 280402 easwarmoorthy2007 Download Post to : URL : Related Presentations : Let's Connect Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Copy embed code: Embed: Flash iPad Dynamic Copy Does not support media & animations Automatically changes to Flash or non-Flash embed WordPress Embed Customize Embed URL: Copy Thumbnail: Copy The presentation is successfully added In Your Favorites. Views: 662 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: April 06, 2011 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript Slide 1: Lotus Apollo Hospital – Erode. Ph : 0424 - 282828Incisional Hernia Prevention and Management: Incisional Hernia Prevention and Management Dr.S.Easwaramoorthy MS FRCS(Eng) FRCS(Glas) Hon FRCS(Edin) Endoscopic and Laparoscopic Surgeon Lotus Apollo HospitalSlide 3: Incisional Hernia are not UncommonIncidence: Incidence Prospective Studies 5 Years : 6% 10 Years : 12% First 2 Years 66-90% of Incisional Hernia Develop in the First 2 Years.Types of Incisional Hernia : Types of Incisional Hernia After Hernia Surgery After Non-hernia Surgery Hysterectomy Caesarian Section Laparoscopic SurgeryAfter Non-hernia Surgery: After Non-hernia SurgeryExamination : Examination Lying StandingIncisional Hernia: Incisional Hernia CT AbdomenSlide 10: An ounce of prevention is worth a pound of cure!Patient Factors: Patient Factors Obesity Diabetes Renal Failure Anaemia and Hypoproteinemia Post Operative Chest InfectionDisease Factors: Disease Factors Peritonitis Visceral Cancer/ascites ColostomySurgeon’s Factors: Surgeon’s Factors Incision Low midline/ Subcostal Drain/Stoma Wound Protection Suturing TechniqueSuturing Technique: Suturing Technique Type of Suture material Absorbable : Vicryl/PDS/Dexon Non absorbable : Nylon/Prolene/Ethibond Size of Suture Technique of SuturingOpen Surgery: Mass Closure: Open Surgery: Mass Closure No 1 Nylon/Prolene/PDS/Vicryl Peritoneum? 1 cm across and 1 cm apart Rule of 4 Burying the knots/Aberdeen knot Handling the tissueLaparoscopic Port Closure: Laparoscopic Port Closure 10 mm and more Not easy Special needle Special devicesSuture repair Vs Mesh: Suture repair Vs Mesh Risk of Recurrence Risk of Infection Randomized clinical trial of suture repair, polypropylene mesh or autodermal hernioplasty for incisional hernia M. Korenkov, S. Sauerland * , M. Arndt † , L. Bograd † , E. A. M. Neugebauer * and H. TroidlSlide 20: Repair of Incisional hernia has High recurrence rate Suture repair : 40% Mesh repair : 10%Problems After the Mesh Repair: Problems After the Mesh Repair Risk of Infection Skin Margin Necrosis Seroma Pain RecurrenceSlide 22: Problems are not due to mesh per se But Where, How and When It is implanted!Anatomy of Incisional Hernia: Anatomy of Incisional HerniaIncise Anterior Rectus Sheath: Incise Anterior Rectus SheathSuturing Over the Defect: Suturing Over the DefectPlacement of Mesh: Placement of MeshClosure of Rectus Sheath: Closure of Rectus SheathLaparoscopic Mesh Repair: Laparoscopic Mesh RepairSlide 29: 21year old lady, Para 1 Large Incisional hernia following c -section Yet to complete her family Surgery Vs Conservative treatment Pregnancy after a mesh repair Mesh repair during C-section Case 1Slide 30: 40 year old obese lady Abdominal hysterectomy 5 years ago Incisional Hernia in Lower midline scar Has Symptomatic Gall stones When to operate? Open /Laparoscopic/Combined Case 2Slide 31: 70 year old frail lady Ovarian Malignancy 6 months after 2 nd look Laparotomy Recent Chemotherapy Conservative Vs Surgery Case 3Slide 32: 35 year old lady Laparoscopic hysterectomy 6 months ago Umbilical Port site Hernia Why? Suture Vs Mesh? Case 4Slide 33: Tomorrow ‘Anything man can imagine will one day be achieved by others’Slide 34: Thank You You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.