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

Laparoscopic Hernia Repair:Incisional/Ventral and InguinalLaparoscopic Hernia Repair:In1What 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.What is a Hernia?DEFECT IN THE2Where Do Hernias Occur?Abdominal WallAt a previous surgical incisionAt the umbilicusAbove the umbilicus(epigastrium)In the inguinal region(groin)Where Do Hernias Occur?Abdomin3Who 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 compromisedWho Requires Treatment?Pain or4Preoperative Work-upEvaluation by SurgeonPhysical ExaminationCT ScanMay or may not be neededAt the discretion of the surgeonPreoperative Work-upEvaluation5Surgical TechniqueKey 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 incorporationSurgical TechniqueKey Componen6Laparoscopic Ventral Hernia10555Laparoscopic PortsHerniaLaparoscopic Ventral Hernia1057Laparoscopic Inguinal Hernia105Laparoscopic PortsHerniaHernia5Laparoscopic Inguinal Hernia108Ventral Hernia DefectVentral Hernia Defect9Mesh Used to Patch Defect Mesh Used to Patch Defect 10Mesh Secured to Abdominal Wall Mesh Secured to Abdominal Wall11Completed Repair Completed Repair 12ComplicationsBleedingMesh InfectionInjury to Adjacent OrgansRecurrenceComplicationsBleeding13AdvantagesDecreased 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)AdvantagesDecreased Wound Comp14