hernia析课件.ppt

Femoral hernia Surgical repair: An incision is made directly over the swelling. The sac is opened and the contents reduced and the sac removed. Femoral canal obliterated with 3 interrupted non absorbable suture. Treatment of strangulation or obstruction, if present. There is no place for a truss in the treatment of femoral hernia. Femoral hernia Umbilical hernia This occurs in children because of incomplete closure of the umbilical orifice. The majority close spontaneously during the first year of life. Surgical repair should only be carried out if the hernia has not disappeared by the age of 3 and the fascial defect is greater than 1.5cm in diameter. Para-Umbilical hernia It occurs just above or just below the umbilicus, and is more common in obese females. Predisposing factors multiple pregnancies and obesity. Para-Umbilical hernia The neck of the sac is usually narrow and therefore there is a high risk of strangulation. The most common content is omentum ,then transverse colon and small intestine. Treatment: is by Contents of sac freed from it’s wall,excision of the sac, and fascial defect repaired by Upper flap overlapping the lower,a two layer overlapping repair thereby doubling the strength of repair (Mayo repair) 4 cm,recurrent-polypropylene mesh Epigastric hernia This is usually a small protrusion through the linea Alba in the upper part of the abdomen. It consists of : extraperitoneal fat only, but May contain omentum or small bowel. Epigastric hernia It may be extremely painful, probably because of trapping and ischaemia of extraperitoneal fat. Treatment is by enlaging the defect,excising the fat, simple suture of the defect with non-absorbable sutures . 4 cm propylene mesh placed retromuscular plane Incisional hernia This occurs through a defect in the scar of a previous abdominal incision. Incisional hernia Etiology : Age: Wound healing is poor in the older patient. Obesity. Postoperative wound infection. Postoperative wound haematoma.