HERNIA

DEFINITION

HERNIA TYPES Primary Incisional

HERNIA Types – Primary Indirect Direct Femoral Spigelian Epigastric Lumbar: Sup.(Grynfeltt’s): Inf.(Petit’s) Obturator Richter’s Sliding

HERNIA TYPES Primary Incisional

HERNIA Types – Incisional Midline Sternotomy Trocar Site Parastomal Lumbar

HERNIA Incisional Hernias – Etiologic Factors Surgeon

HERNIA Incisional Hernias –Etiologic Factors Surgeon Infection Tension Exercise Obesity Ascites Smoking and Chronic Cough Steroids Malnutrition Advanced Age Diabetes Collagen Disorders

HERNIA Indications for Repair

HERNIA Indications for Repair Strangulation Incarceration Local Symptoms Patient Preference Extenuating Circumstances Travel Insurance Work

HERNIA Repairs Open Primary Mesh Laparoscopic TAPP TEP

HERNIA Repairs Open Primary Non-absorbable suture Absorbable suture Separation of components technique Mesh Laparoscopic

HERNIA Repairs Open Primary – Types Bassini McVay Halstead Shouldice Nyhus-Condon Mesh Laparoscopic

HERNIA Repairs Open Primary Mesh – Types Lichtenstein Plug and Patch Kugel Stoppa Laparoscopic

HERNIA Repairs Open Primary Mesh Polypropylene ePTFE Dual Composites Biologic Laparoscopic

HERNIA Repairs Open Primary Mesh – Technical Issues Overlay/Underlay Smooth Seating Fixation Sutures Tacks Adhesion Laparoscopic

HERNIA Repairs Open Primary – Complications Recurrence Infection Bleeding Nerve Injury Seroma Mesh Laparoscopic

HERNIA Recurrent Hernias – Etiologic Factors Surgeon Missed direct, indirect, or femoral component Inadequate medial closure Inadequate dissection of the sac Inadequate closure of the internal ring

HERNIA Repairs Open Primary Mesh – Complications Recurrence Infection Bleeding Nerve Injury Seroma Adhesions Fistula Bulk Laparoscopic

HERNIA Repairs Open Primary Mesh Laparoscopic – Complications Recurrence Infection Bleeding Nerve Injury Seroma Adhesions Intestinal Injury Fistula

HERNIA Potentially Injured Nerves Ilio-inguinal Ilio-hypogastric Genitofemoral Femoral Obturator

HERNIA Laparoscopic vs. Open Consensus Advantages Bilateral hernias Recurrences of open repairs Femoral hernias Debatable Advantages Recurrence rate Comfort Return to normal activities Negatives Cost to hospital Learning curve Unknowns Infection rate Chronic pain