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    Hernias: MS3 Didactic Series

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    The document discusses hernias, including their definition, locations, risk factors, complications, diagnostic imaging, and surgical repair options and techniques. Hernias are defects in the abdominal wall that can be repaired through open or laparoscopic surgery, often using synthetic or biologic mesh placed intraperitoneally or preperitoneally.

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    Hernias: MS3 Didactic Series

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    bloadyroar
    39 views23 pages
    The document discusses hernias, including their definition, locations, risk factors, complications, diagnostic imaging, and surgical repair options and techniques. Hernias are defects in the abdominal wall that can be repaired through open or laparoscopic surgery, often using synthetic or biologic mesh placed intraperitoneally or preperitoneally.

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    lecture for herniasien

    Original Title

    Hernia MS3 Lecture

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    The document discusses hernias, including their definition, locations, risk factors, complications, diagnostic imaging, and surgical repair options and techniques. Hernias are defects in the abdominal wall that can be repaired through open or laparoscopic surgery, often using synthetic or biologic mesh placed intraperitoneally or preperitoneally.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    39 views23 pages

    Hernias: MS3 Didactic Series

    Uploaded by

    bloadyroar
    The document discusses hernias, including their definition, locations, risk factors, complications, diagnostic imaging, and surgical repair options and techniques. Hernias are defects in the abdominal wall that can be repaired through open or laparoscopic surgery, often using synthetic or biologic mesh placed intraperitoneally or preperitoneally.

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    © All Rights Reserved
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    of 23

    HERNIAS

    Paul Montero, MD
    Kevin Rothchild, MD
    Assistant Professor
    Surgery
    University of Colorado Denver

    MS3 Didactic Series

    Surgical Consultation Requested


    42 y/o male
    CC: abdominal pain
    HPI: Was lifting a box last month, noted a tearing pain and
    eventually an associated, enlarging lump just above umbilicus
    which is soft. No n/v/c/d/f. Pain is constant, stable, moderate,
    and does not radiate. Exacerbated by exertion, sneezing.
    PMHx: GERD, HTN, Obesity
    PSHx: open Nissen fundoplication 2004
    SHx: no ETOH, ppd tobacco x 12 years
    FHx: diabetes, obesity

    Physical Exam

    98.7 78 142/85 16 94% RA


    59 224 lbs BMI: 33
    A+Ox3, NAD, CTA B, RRR, No
    Edema, EOMI, No icterus
    Soft, reducible, mildly tender bulge
    in previous midline incision. Skin
    intact and healthy.

    What is a Hernia?

    What is a Hernia?

    A defect, weakening, or hole in the abdominal


    wall where it should not be (from the latin for
    rupture)

    Areas of weakness: umbilicus, hiatus, inguinal canal


    Previous incision
    There are also internal hernias (rare)

    Famous Hernias: inguinal (direct, indirect,


    pantaloon), umbilical, ventral, femoral, hiatal,
    flank, spigelian, obturator

    Hernia Locations

    Hernias

    4-5 million laparotomies performed in the US each year


    Reported incidence of ventral hernia is 2 25%
    150,000-500,000 hernias repaired annually in U.S.
    Hernia repair is the most commonly performed surgery
    worldwide

    Choi et al. Annals of Surgery 2012


    Breuing et al. Surgery 2010

    Hernia Imaging

    US, CT

    What complications can occur from


    Hernias?

    What complications can occur from


    Hernias?

    Natural History: slowly get bigger, never go away


    on their own (*there is one exception)
    Symptoms: pain, obstruction, unsightly bulge,
    impeded function
    Incarceration
    Strangulation
    Erosion of hernia sac through
    weak

    skin

    What factors mitigate Hernia


    formation/enlargement/recurrence?

    What factors mitigate hernia


    formation/enlargement/recurrence?
    Weakened tissue

    Force applied to tissue

    What factors mitigate hernia


    formation/enlargement/recurrence?

    Weakened tissue
    Smoking
    Age
    Steroids
    Immunosuppressive Meds
    Collagen disorders
    Surgical Wounds

    Force applied to tissue


    Heavy lifting
    Obesity
    Constipation
    Coughing
    Difficulty urinating

    What factors mitigate hernia


    formation/enlargement/recurrence?

    Weakened tissue
    Smoking
    Age
    Steroids
    Immunosuppressive Meds
    Collagen disorders
    Surgical Wounds

    Force applied to tissue


    Heavy lifting
    Obesity
    Constipation
    Coughing
    Difficulty urinating

    What are the management options


    for a Hernia?

    What are the management options for


    a hernia?

    Observation

    Support (truss, binder)

    Repair

    What are the Surgical Techniques used


    for Hernia Repair?

    What are the Surgical Techniques used


    for Hernia Repair?
    Open Repair
    Laparoscopic Repair
    Mesh
    Type
    Location of Placement

    What are the Surgical Techniques used


    for Hernia Repair?
    Open Repair
    Laparoscopic Repair
    Mesh
    Type
    Location of Placement

    Factors to Consider:
    Size of hernia
    Location of hernia
    # of hernias
    Patient Comorbidities
    Experience of Surgeon
    Mesh availability

    Types of Mesh

    Synthetic:
    Absorbable: polygalactin 910 [Vicryl], polyglycolic acid
    [Dexon]
    Non-absorbable: polypropylene [Marlex, Prolene], and
    expanded polytetrafluoroethylene [ePTFE, Gortex]

    Biologic:

    From Sabiston Textbook of Surgery, 19th Ed 2012

    Mesh: Location of Placement

    From Sabiston Textbook of Surgery, 19th Ed 2012

    Laparoscopic Repair

    http://www.youtube.com/watch?v=-g9wfx6m9LA

    Additional Reading:
    Luijendijk et al. NEJM 2000

    Heniford et al. Annals of Surgery 2003

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