incisional hernia 280402

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Slide 1:

Lotus Apollo Hospital – Erode. Ph : 0424 - 282828

Incisional 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 Hospital

Slide 3:

Incisional Hernia are not Uncommon

Incidence:

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 Surgery

After Non-hernia Surgery:

After Non-hernia Surgery

Examination :

Examination Lying Standing

Incisional Hernia:

Incisional Hernia CT Abdomen

Slide 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 Infection

Disease Factors:

Disease Factors Peritonitis Visceral Cancer/ascites Colostomy

Surgeon’s Factors:

Surgeon’s Factors Incision Low midline/ Subcostal Drain/Stoma Wound Protection Suturing Technique

Suturing Technique:

Suturing Technique Type of Suture material Absorbable : Vicryl/PDS/Dexon Non absorbable : Nylon/Prolene/Ethibond Size of Suture Technique of Suturing

Open 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 tissue

Laparoscopic Port Closure:

Laparoscopic Port Closure 10 mm and more Not easy Special needle Special devices

Suture 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. Troidl

Slide 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 Recurrence

Slide 22:

Problems are not due to mesh per se But Where, How and When It is implanted!

Anatomy of Incisional Hernia:

Anatomy of Incisional Hernia

Incise Anterior Rectus Sheath:

Incise Anterior Rectus Sheath

Suturing Over the Defect:

Suturing Over the Defect

Placement of Mesh:

Placement of Mesh

Closure of Rectus Sheath:

Closure of Rectus Sheath

Laparoscopic Mesh Repair:

Laparoscopic Mesh Repair

Slide 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 1

Slide 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 2

Slide 31:

70 year old frail lady Ovarian Malignancy 6 months after 2 nd look Laparotomy Recent Chemotherapy Conservative Vs Surgery Case 3

Slide 32:

35 year old lady Laparoscopic hysterectomy 6 months ago Umbilical Port site Hernia Why? Suture Vs Mesh? Case 4

Slide 33:

Tomorrow ‘Anything man can imagine will one day be achieved by others’

Slide 34:

Thank You