腹外疝及少见疝气的诊断和治疗（英文版）课件

HERNIAS Presented by: Alshebani M. FadelAl- caused by hernia compression of the obturator nerve. EXAMINATION: Hernias must be examined with the patient standing and in supine Always examine both groins. INSPECTION: Visible swelling. (site, size and shape) Visible cough impulse. Easily reducible Reappear on straining, standing or coughing Elucidate Fothergill and Carnet signs. PALPATION: Examine as a mass and then Palpable cough impulse Reduce Occlusion test Three Finger test ( Zimmans test) Examination also asses the following: Position Temperature Tenderness Shape Size Tension Composition Expansile cough impulse Reducible. PERCUSSION AND AUSCULTATION: Bowel sound. Treatment Most abdominal hernias can be surgically repaired. Uncomplicated hernias are principally repaired by herniorrhaphy. a Herniorrhaphy (Hernioplasty) is a surgical procedure for correcting hernia, which can be devided into four techniques: Groups 1 and 2: open “tension“ repair: nin which the edges of the defect are sewn back together without any reinforcement or prosthesis. In the Bassini technique, the conjoint tendon (formed by the distal ends of the transversus abdominis muscle and the internal oblique muscle) is approximated to the inguinal canal and closed. 4 nAlthough tension repairs are no longer the standard of care due to the high rate of recurrence of the hernia, long recovery period, and post-operative pain, a few tension repairs are still in use today. Treatment (cont) Group 3: open “tension-free“ repair: nAlmost all repairs done today are open “tension -free“ repairs that involve the placement of a synthetic mesh to strengthen the inguinal region. nThis operation is called a hernioplasty. The meshes used are typically made from polypropylene or polyester. The operation is typically performed under local anesthesia, and patients go home within a few hours of surgery, often requiring no medication beyond aspirin or acetaminophen. nRecurrence rates are very low - one percent or less, compared with over 10% for a tension repair Treatment (cont) Group 4: laparoscopic repair n“Lap“ repairs are also tension-free, although the mesh is placed within the preperitoneal space behind the defect as opposed to in or over it. nIt is further sub-devided into: T.A.P.P repair (transabdominal preperitoneal) T.E.P repair (totally extraperitoneal) nIt has no proven superiority to the open method other than a faster recovery time and a slightly lower post-operative pain score. nlaparoscopic surgery, though, requires general anesthesia, more expensive and consumes more O.R. time than open repair