Transcript HERNIA - St. Luke's-Roosevelt Hospital Center

HERNIA
HERNIA
HERNIA
DEFINITION
HERNIA
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TYPES
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Primary
Incisional
HERNIA
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Types – Primary
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Indirect
Direct
Femoral
Spigelian
Epigastric
Lumbar: Sup.(Grynfeltt’s): Inf.(Petit’s)
Obturator
Richter’s
Sliding
HERNIA
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TYPES
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Primary
Incisional
HERNIA
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Types – Incisional
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Midline
Sternotomy
Trocar Site
Parastomal
Lumbar
HERNIA
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Incisional Hernias – Etiologic Factors
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Surgeon
HERNIA
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Incisional Hernias –Etiologic Factors
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Surgeon
Infection
Tension
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Exercise
Obesity
Ascites
Smoking and Chronic Cough
Steroids
Malnutrition
Advanced Age
Diabetes
Collagen Disorders
HERNIA
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Indications for Repair
HERNIA
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Indications for Repair
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Strangulation
Incarceration
Local Symptoms
Patient Preference
Extenuating Circumstances
Travel
 Insurance
 Work
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HERNIA
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Repairs
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Open
Primary
 Mesh
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Laparoscopic
TAPP
 TEP
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HERNIA
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Repairs
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Open
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Primary
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Non-absorbable suture
Absorbable suture
Separation of components technique
Mesh
Laparoscopic
HERNIA
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Repairs
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Open
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Primary – Types
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Bassini
McVay
Halstead
Shouldice
Nyhus-Condon
Mesh
Laparoscopic
HERNIA
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Repairs
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Open
Primary
 Mesh – Types
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Lichtenstein
Plug and Patch
Kugel
Stoppa
Laparoscopic
HERNIA
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Repairs
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Open
Primary
 Mesh
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Polypropylene
ePTFE
Dual Composites
Biologic
Laparoscopic
HERNIA
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Repairs
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Open
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Primary
Mesh – Technical Issues
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Overlay/Underlay
Smooth Seating
Fixation
 Sutures
 Tacks
 Adhesion
Laparoscopic
HERNIA
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Repairs
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Open
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Primary – Complications
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Recurrence
Infection
Bleeding
Nerve Injury
Seroma
Mesh
Laparoscopic
HERNIA
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Recurrent Hernias – Etiologic Factors
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Surgeon
Missed direct, indirect, or femoral component
 Inadequate medial closure
 Inadequate dissection of the sac
 Inadequate closure of the internal ring
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HERNIA
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Repairs
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Open
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Primary
Mesh – Complications
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Recurrence
Infection
Bleeding
Nerve Injury
Seroma
Adhesions
Fistula
Bulk
Laparoscopic
HERNIA
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Repairs
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Open
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Primary
Mesh
Laparoscopic – Complications
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Recurrence
Infection
Bleeding
Nerve Injury
Seroma
Adhesions
Intestinal Injury
Fistula
HERNIA
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Potentially Injured Nerves
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Ilio-inguinal
Ilio-hypogastric
Genitofemoral
Femoral
Obturator
HERNIA
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Laparoscopic vs. Open
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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
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Chronic pain