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    The Abdominal Wall

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    arshmeentariq
    The document discusses the abdominal wall and different types of hernias. It describes the layers of the abdominal wall and defines a hernia as a protrusion of an organ or tissue through an abnormal opening. It then discusses different types of hernias like inguinal, femoral, ventral and umbilical hernias. For each hernia, it provides information on symptoms, risk factors and surgical repair methods. In general, hernias are often repaired surgically using either tissue or mesh to reconstruct the abdominal wall.

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    The Abdominal Wall

    Uploaded by

    arshmeentariq
    31 views32 pages
    The document discusses the abdominal wall and different types of hernias. It describes the layers of the abdominal wall and defines a hernia as a protrusion of an organ or tissue through an abnormal opening. It then discusses different types of hernias like inguinal, femoral, ventral and umbilical hernias. For each hernia, it provides information on symptoms, risk factors and surgical repair methods. In general, hernias are often repaired surgically using either tissue or mesh to reconstruct the abdominal wall.

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    The document discusses the abdominal wall and different types of hernias. It describes the layers of the abdominal wall and defines a hernia as a protrusion of an organ or tissue through an abnormal opening. It then discusses different types of hernias like inguinal, femoral, ventral and umbilical hernias. For each hernia, it provides information on symptoms, risk factors and surgical repair methods. In general, hernias are often repaired surgically using either tissue or mesh to reconstruct the abdominal wall.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    31 views32 pages

    The Abdominal Wall

    Uploaded by

    arshmeentariq
    The document discusses the abdominal wall and different types of hernias. It describes the layers of the abdominal wall and defines a hernia as a protrusion of an organ or tissue through an abnormal opening. It then discusses different types of hernias like inguinal, femoral, ventral and umbilical hernias. For each hernia, it provides information on symptoms, risk factors and surgical repair methods. In general, hernias are often repaired surgically using either tissue or mesh to reconstruct the abdominal wall.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 32

    The Abdominal Wall

    And Hernias
    Dr MUHAMMAD UMAR YOUNIS
    ABDOMINAL WALL
    • The structure of the abdominal wall is similar in principle to the thoracic wall.
    • There are three layers, an external, internal and innermost layer.
    • The vessels and nerves lie between the internal and innermost layers.
    THE FASCIA
    • Below the skin the superficial fascia is divided into a superficial fatty layer, Camper's
    fascia, and a deeper fibrous layer, Scarpa's fascia.
    • The deep fascia lies on the abdominal muscles. Inferiorly Scarpa's fascia blends with
    the deep fascia of the thigh. This arrangement forms a plane between Scarpa's fascia
    and the deep abdominal fascia extending from the top of the thigh to the upper
    abdomen.
    • Below the innermost layer of muscle, the transversus abdominis muscle, lies the
    transversalis fascia. The transversalis fascia is separated from the parietal peritoneum
    by a variable layer of fat.
    THE MUSCLES
    HERNIA - Definition
    • A hernia is a protrusion of a viscus or part of a viscus through an abnormal
    opening in the walls of its containing cavity .
    Etiology
    • Congenital defects.
    • Loss of tissue strength and elasticity (from aging or repetitive stress).
    • Operative Trauma.
    • Increased Abdominal Pressure (heavy lifting, COPD, BPH, Ascites, Obesity).
    Inguinal hernia
     History:
    1. Age ( young vs. old)
    2. Occupation ( nature ?? )
    3. Local symptoms: Swelling, discomfort and pain
    4. Systemic symptoms: if there is obstruction or strangulation
    5. Precipitating factors
    Clinical Types of Inguinal Hernia
     Indirect inguinal hernia:
    the internal inguinal ring  the inguinal canal  external inguinal ring scrotum

    Direct inguinal hernia: Hesselbach’s triangle


    Pantaloon type
    INGUINAL HERNIA
    FEMORAL HERNIA
    History
     Age ; uncommon in children , most common in old age female .
     Sex; women > men (but still commonest hernia in women the inguinal hernia )
     The patient came with local symptoms
     1- discomfort and pain
     2- swelling in the groin
     General ; femoral hernia is more likely to be strangulated than the inguinal hernia
     Multiplicity ; often bilateral
    • In a femoral hernia the hernia sac is pushed into the femoral canal, below the inguinal
    ligament and between the lacunar ligament and the femoral vein.
    • The hernia sac thus lies inferior and lateral to the pubic tubercle and anterior to the
    superior pubic ramus periosteum (COOPER’S LIGAMENT)
    VENTRAL HERNIAS
    UMBILICAL HERNIA
    • Signs and symptoms
    • Age : doesn’t appear until the umbilical cord has separated and healed .
    • No specific symptoms
    • Have wide neck and reduce easily , rarely give intestinal obstruction.
    • Nature history ; 90 % disappear spontaneously during the first year.
    Acquired umbilical hernia

     Hernia through the umbilical scar , so it is a true umbilical hernia.


     Not common and is usually secondary to increase intra abdominal pressure.
     The most common causes:
     1- pregnancy
     2- ascites
     3- ovarian cyst
     4- fibroids
     5- bowel distention
    Epigastric Hernia

     Occurring between the navel and the lower part of the rib cage in the midline of the
    abdomen, these hernias are composed usually of fatty tissue and rarely contain intestine.
     Men > Women
     these hernias are often painless and unable to be pushed back into the abdomen when
    first discovered.
    Spigelian Hernia
     Rare
    Hernia through subumbilical portion of semi-lunar
    line
    Difficult to diagnose –Abdominal pain or mass
    noted in abdominal wall. Frequently tender over
    area
     Clinical suspicion (location)
     CT scan

     Repair primarily or with mesh


    MANAGEMENT
    • Most pt are treated surgically
    • Increase IAP abnormalities (Chronic cough, Constipation, Bladder outlet obstruction)
    should be evaluated and remedied to extent possible before elective herniorrhaphy.
    • In case of intestinal obstruction and possible strangulation, Broad spectrum AB,NG
    suction may be indicated, correction of volume status& elctroyles.
    Primary tissue repair

    • Bassini repair: inferior arch of transversalis fascia (TF) or conjoint tendon is


    approximated to shelving portion of inguinal ligament.

    • McVay: TF is sutured to cooper ligament.

    • Shouldice: TF is incised and reapproximated.


    Laproscopic &
    preperitoneal repairs

    • TAPP (transabdominal prepeitoneal procedure): peritoneal space entered by


    conventional lap at umbilicus and peritoneum overlaying inguinal floor is
    dissected away as flap.

    • TEP (Total extraperitoneal repair): preperitoneal space is developed with a


    balloon inserted between posterior rectus sheath and peritoneum  balloon
    inflated to dissect the peritoneal flaps awau from posterior abdomianl wall and
    the direct and indirect spaces, other ports inserted into this preperitoneal space
    without entering peritoneal cavity.

    • After lap. Dissection and reduction of hernia sac , a large piece of mesh is
    placed over inguinal floor
    Open tension free
    repair
    • Lichtenstein repair &Patch and Plug technique: Mesh is used to reconstruct inguinal
    floor

    • Mesh plug technique : place mesh in the hernial defect


    Femoral Hernia Repair
    Three approaches have been described for open surgery :
    1. Infra-inguinal approach (Lockwood)
    2. Inguinal approach ( Lotheissen)
    3. High approach ( McEvedy)
    Incisional Hernia

     an abnormal protrusion of a viscus through the musculoaponeurotic layers of a


    surgical scar.
     Swelling and mass in the incision
     Rarely incarcerate
    Etiology
    Operative factors:
    - types of incision: vertical incision, transrectus incision, midline incision,
    standard paramedian incision
    - technique of closure
    - suture material
    Postoperative factors:
    - increased intra-abdominal pressure
    - Obesity
    - Malnutrition
    - Smoking
    -Immune dificiency
    Repair
    • Bring together fresh fascial edges after trimming sac
    • Clean off fascial edges at least 1 cm back
    • Close with interrupted or continuous sutures
    • Even with careful technique recurrence rates as high as 50% have been reported
    Thank You

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