腹股沟区和腹壁解剖和手术.ppt

* * * * It is important to understand the abdominal wall anatomy. Of particular note is Linea alba (white line) Rectus abdominus muscle Anterior layer of the rectus sheath Transversalis fascia Posterior layer of the rectus sheath Peritoneum * In addition, it is important to know and understand the other layers External Oblique * Internal oblique And the rectus abdominus muscle * * * There are basically three types of repair for the ventral/incisional hernia Primary Repair (suture) Mesh Repair – Open Mesh Repair- Laparoscopic * Most Ventral /Incisional hernia repairs performed in the US are done tension free i.e.: with the use of a prosthetic device. This will vary from country to country * Sometimes the ventral/incisional hernia is very difficult to treat due to its location * This is one of the landmark publications that show the key difference between a tension and tension free repair. This is important to memorize! * This publication was unique in that it actually measured the difference in recurrence rates depending on the size of the repairs It demonstrated that if a hernia defect is larger than 4cm, there is a much greater chance of recurrence should a prosthetic not be used. This is extremely important for those surgeons who believe that smaller hernias do not need a prosthetic device and they simply suture the repair. * These are the ideal characteristics of a mesh used for ventral hernia repair. Most prosthetic devices used will have these fundamental characteristics Where the modifications take place is in the actual construction of the prosthetic * * By way of review, it is important to remember that a hernia is a defect in the wall that allows the extrusion of tissues normally contained by that wall. The most common types of hernias include epigastric, femoral, incisional, inguinal, umbilical, and ventral. Inguinal hernias, which can be divided into indirect and direct hernias, are by far the most common. Gilbert1 and Condon2 described their i