Incisional Dr. Perez Martin Hosp.

Guest Concept • From the Latin: ex, out and venter, meaning belly, protruding abd visors • Thi s should occur in a place where no weak spot or hole preexists natural • Differe nce hernias Defects of the anterior abdominal wall • • • • Diastasis Laparocele bossing or "bulge" Eventration • • • • Post traumatic laparotomy Post Post Post sepsis resection of cancer Healing Concepts • Two groups in the restoration of any solution of continuity tis: - Inherent to the patient: • Condition psychophysical • Stress • Normoalimentación - Inherent to the external environment • Dependent surgeon - Maneuvers, hemostasis, suture tension etc. • Dependents of the wound - Cont bacterial, trauma to the wound, associated enf Factors involved in the repair • • • • Inflammation Metabolism of collagen contraction epithelialization Chronology in the healing • First 18 hours influx of PMN • At 48 pm ↑ of macrophages and replaced by fibro blasts • At the 4th day colagenogénica repair and start the contraction phase • 15 days the wound is repaired • 5th week at 3 months ↑ contraction phase gradual ly gives way to the 6th month • The tensile strength and strain to normal year Classification Acute open or closed immediately eviscerated simple 1st grade 2nd grade 3rd grad e 2nd grade 1st grade eventration or mediate Chronicle Primary Secondary Acute eventration • Synonyms: - Postoperative eventration - burst or rupture abdominal dehiscence - Spontaneou s Evisceration • By convention it is considered that may appear in the corresponding period to 30 days after the surgery • Higher incidence in sex masc 2.8 / 1 • Occurs in all ages with a prevalence between 50 and 60 • Absolute frequency between 0.3 and 3 % of abdominal operations causes • Preoperative: - Factors ↑ abdominal pressure "bronchopulmonary Pathology" urinary tract pathol ogy "Obesity - homeostatic" thrombocytopenia "Anemia, hypoproteinemia" Diabetes, uremia, vitamin deficiencies - Immune System Disorders »Leukopenia» AIDS causes • Operative: - Surgical technique • Incision • Summary • suture material

- Time-operative - Wake anesthetic • Rigging resp tract cleaning • Anticipating at closing causes • Post operative: - Abdominal distension • Ileus - Paralytic - Mechanical • Globe bladder etc. - Surgical wound infection classification Acute open or closed immediately eviscerated simple 1st grade 2nd grade 3rd grad e 2nd grade 1st grade eventration Open evisceration • Simple or retained: - The viscera are kept in the background with no tendency to cross the plane of the peritoneum • With evisceration: - Guts and / or the omentum out of the abdominal cavity (Finochietto) • First degree: not reach the level of the skin • Second level: a sector of the diameter visceral than cutaneous cover • Third degree: exceeds the mesenteric bo rder of the skin line classification • Cover Type I - The skin on TCS and peritoneum are undamaged • Cover type II: • Only the skin is free, clinic • Covers can be oligosymptomatic or asymptomatic • The early onset of a chronic hernia is usually the result of this prolonged episode • State sub-fever, tachyc ardia, discomfort in the scar and abdominal strain resistant to treatment should raise suspicion of a cover eventration • Tale of a clear noise or tearing sensa tion accompanied by pain • Drainage of serous fluid, pink salmon in the wound clinic • • • • • • • Inspection Auscultation Percussion Palpation Rx Ultrasound CT complications • Systemic - Hydro electrolyte imbalance - Sepsis • Local - - - - - Infection wall Strangulation intestinal obstruction intestinal bleedin g fistula treatment • Covers: - Expectant - Surgical • Open - Grade I and II

• With infection • No infection Chronic Eventrations Eventration is called chronic disruption of the abdominal wall through a hole un natural, after the 30 days of its synthesis classification Umbilicopubiana Xifoumbilical or higher or lower midline of the cord or half or full Xifopubiana (Sibilla) Lateral quadrant right Lower Higher Lower Higher left posterolateral costolumboilíaca classification topographic supraubmilicales infraumbilical suprainfraumbilicales (Garritz and Gonzalez) Median lateral paramedian Complicated recurrent complex Eventrations Pericolostómicas neighboring bones Classification Epigastric suprainfraumbilicales infraumbilical Supraubilicales vertical transve rse or oblique hypogastric paraumbilical Barrotaveña Lateral paramedian Medium Superior lateral posterolateral lower Paraubilicales costolumboilíacas classification Depending on the size small Up to 2 cm in diameter cross support moderate Of 2-5 cm large Of 5-10 cm giants

Over 10 cm Predisposing factors Relationships with patients Age-sex Hypoproteinemia Hipoascorbinemia Anemias-hypovolemia Malignancies Obesit y Diabetes Drug Allergy-irradiation immunity Anesthesia Related to the operation Tactics and surgical incision suture material Drainage Related Disease infections Triggers Increased abdominal pressure Increase in the Vomiting Cough dyspnea ileus Ascites Increased muscle tone parietal diagnosis • • • • • • • Inspection Interrogation TAC Ultrasound Palpation Auscultation Rx treatment • Notions of pneumoperitoneum GoñiMoreno • Notions of parietal prosthesis use on tummy • Notions • Notions of laparoscopic eventroplstias