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1

Incisional Hernia

* Alternative name

* Definition

* Types

* Etiology

* Clinical picture

* Treatment

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Alternative name for Incisional Hernia

Ventral Hernia

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Definition of Incisional Hernia

* a hernia that develops at the site of a previous abdominal incision,

* usually within 1 year after the operation

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Types of Incisional Hernia

1. Cicatricial Incisional Hernia

2. Paralytic Incisional Hernia

* Difference between Cicatricial and Paralytic

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Pathogenesis of Cicatricial Incisional Hernia in Types of Incisional Hernia

Due to defective closure & muscular defect

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Pathogenesis of Paralytic Incisional Hernia in Types of Incisional Hernia

* Direct hernia following appendectomy with muscle cutting incision

* Incisional hernia following Kocher's incision

* Lumbar hernia following Morris' incision

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Pathogenesis of Direct hernia following appendectomy with muscle cutting incision in Pathogenesis of Paralytic Incisional Hernia in Types of Incisional Hernia

due to injury of the ilioinguinal nerve )> Paralysis of conjoint tendon )> weakens inguinal triangle )> direct hernia

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alternative name for Kocher's incision in Pathogenesis of Paralytic Incisional Hernia in Types of Incisional Hernia

subcostal incision

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Pathogenesis of Incisional hernia following Kocher's incision in Pathogenesis of Paralytic Incisional Hernia in Types of Incisional Hernia

due to damage of intercostal nerves 8, 9 & 10 which are the Nerve supply of muscles of anterior abdominal wall

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Alternative name for Morris' incision in Pathogenesis of Paralytic Incisional Hernia in Types of Incisional Hernia

Lumbar incision

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Pathogenesis of Lumbar hernia following Morris' incision in Pathogenesis of Paralytic Incisional Hernia in Types of Incisional Hernia

due to damage of subcostal nerve.

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Difference between Cicatricial and Paralytic in Types of Incisional Hernia

Feeling of a defect on hernia reduction with cicatricial Incisional Hernia

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Etiology of Incisional Hernia

A- Preoperative factors

B- Operative factors

C- Post Operative factors

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Preoperative factors in Etiology of Incisional Hernia

1- Obesity.

2- Poor health condition

3- Respiratory problems

15

Poor health condition in Preoperative factors in Etiology of Incisional Hernia

as D.M, cirrhosis, steroid therapy.

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Respiratory problems in Preoperative factors in Etiology of Incisional Hernia

Chronic bronchitis or asthma

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Operative factors in Etiology of Incisional Hernia

1. Muscle cutting incisions instead of muscle splitting incisions.

2. Use of absorbable sutures in abdominal closure specially midline

3. Insertion of drains though the main wound.

4. Injury of nerves (paralytic incisional hernia).

5. Rough surgical technique.

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Pathogenesis of Use of absorbable sutures in abdominal closure specially midline in Operative factors in Etiology of Incisional Hernia

absorbable sutures are absorbed before healing of the muscle occurs

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Post Operative factors in Etiology of Incisional Hernia

1. Post operative wound hematoma or infection.

2. Poor recovery from anaesthesia.

3. Persistent increase of intra-abdominal pressure.

20

Most common factor in Etiology of Incisional Hernia

Post operative wound hematoma or infection

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CLINICAL PICTURE of Incisional Hernia

* Painless swelling with expansile impulse on cough at site of previous operation.

* A defect is detected in the cicatricial type only

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TREATMENT of Incisional Hernia

* Surgery is the only line of TTT

* Modalities of repair

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Modalities of repair in TREATMENT of Incisional Hernia

1- Hernioplasty

2- Anatomical repair

3- Keel repair

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Best modality in Modalities of repair in TREATMENT of Incisional Hernia

Hernioplasty

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Principle of Anatomical repair in Modalities of repair in TREATMENT of Incisional Hernia

Each layer is sutured separately.

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Keel repair in Modalities of repair in TREATMENT of Incisional Hernia

* Meaning of Keel

* Alternative name

* Principle

* Disadvantages

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Meaning of Keel in Keel repair in Modalities of repair in TREATMENT of Incisional Hernia

قاع المركب

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Alternative name for Keel repair in Modalities of repair in TREATMENT of Incisional Hernia

Maingot repair

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Principle of Keel repair in Modalities of repair in TREATMENT of Incisional Hernia

* The sac is dissected "not opened" & inverted inside the abdomen.

* The defect is closed by a series of interrupted sutures.

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Disadvantages of Keel repair in Modalities of repair in TREATMENT of Incisional Hernia

The non obstructive adhesions may become obstructive Leading to intestinal obstruction