腹腔镜疝修补术(英文版)LaparoscopicVentralHerniaRepair课件.ppt

Laparoscopic Hernia Repair:Incisional/Ventral and Inguinal,What is a Hernia?,DEFECT IN THE FASCIAThe fascia is the strength layer surrounding the abdominal cavityA defect in that layer allows intra-abdominal contents(i.e.fat,intestines)to bulge through the defect.,Where Do Hernias Occur?,Abdominal WallAt a previous surgical incisionAt the umbilicusAbove the umbilicus(epigastrium)In the inguinal region(groin),Who Requires Treatment?,Pain or DiscomfortEnlarging HerniasIntestinal ObstructionNausea,Vomiting,Abdominal DistentionIncarceration or StrangulationHernia Contents are trapped and painfulAbdominal Pain and/or a Painful BulgeBlood Supply to trapped contents may be compromised,Preoperative Work-up,Evaluation by SurgeonPhysical ExaminationCT ScanMay or may not be neededAt the discretion of the surgeon,Surgical Technique,Key Components:Reduce the hernia contents“Patch”the defect in the fascia with MeshMesh is incorporated into the abdominal wall by the bodyReinforces the defect in the fasciaSecure the Mesh to the abdominal wallPrevent movement of the mesh prior to incorporation,Laparoscopic Ventral Hernia,10,5,5,5,Laparoscopic Ports,Hernia,Laparoscopic Inguinal Hernia,10,5,Laparoscopic Ports,Hernia,Hernia,5,Ventral Hernia Defect,Mesh Used to Patch Defect,Mesh Secured to Abdominal Wall,Completed Repair,Complications,BleedingMesh InfectionInjury to Adjacent OrgansRecurrence,Advantages,Decreased Wound ComplicationsPotentially,theorize decrease recurrences;exposes entire undersurface to identify small defects that lead to recurrencesLaparoscopic repair can diagnose the“Swiss cheese”herniasEffective modality for recurrent hernias that have been repaired anteriorly(Open),