GENERAL SURGERY

Surgical options
>
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ANTERIOR MESH REPAIRS (all open)
·

Lichensteir Repair

Mesh-Plug Repair
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Prolene Hernia System

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PREPERITONEAL REPAIRS (all open)
Stoppa Repair
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Kugel Repair
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LAPAROSCOPIC REPAIRS

Totally Extraperitoneal Repair

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Transabdominal Preperitorial Repair

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LATTONGLEGERDIN
FERNTAREPAIR Maoma(focal,RMswelling
/

<
in
To region of this, e

Rare Ischemic orChitis D testicular atrophy chronic testicular

·

: on severe pain
nerve
injury
= numbness or
neuralgia (chronic pain)
↳ recurrent hernia : Causes

↳ failure to at 1st op
diagnose multiple hernias .

↳ "to close an
enlarged
internal
ring
TYPES ↳
excessive tension on the
repair - Hematoma =
dislodged mesh (fac
aparoscopi
·
Incisional Hernia
>
-
incidence of 10 % after laparotomy
-
causes :
deep would infection , poor surgical technique, poor wound healing due to

cirrhosis
,
malnutrition , malignancy immunosuppression
,
and steroid
dependency
Tabdominal pressure (causes :
Obesity ,
DPOC , constipation , color/prostate
a
·
Pantaloon Hernia : simultaneous occurence of a direct Findirect hernia
·

Sliding Hernia portion of the wall of the

:

protruding peritoneal sae is made of some

intra-abdom
Organ (ex sigmoi , ceam)
.

:
 partide/absent
I

·
Richter's Hernia :

only a
portion of the small bowel
inconcerates/strangulates bowel obstruction
·

Spigelian Hernia :
through the semilunar line

Grynfelt's Hernia through the superior lumbon triangle

·

·
Petit's Hernia :
""inferior" 21

·
Litre's Hernia Amyand's Hernia Obturator Hernia ·

Hesselbach's Hernia

Epigastric Hernia
·

ESTIONS :

What are common causes for hernias ?

congenital predispositions/malformation
·

weakening of the abdominal wall secondary to

invision/trauma
·

an

patients W/ collagen vascular disease and connective tissue disorders

increased abdom (pregnancy straining due to constipation , DPOC , strenuous

·

pressure ,

activity
, chronic cough)

What are characteristics of incarcerated hernias ?

painful enlargement of a previous hernia/ defect

cannot be manipulated (either spontaneously or
manually) through
the fascial defect
of bowel obstruction
vomiting and possible symptoms
·

nausea ,

What are characteristics of strangulated hernias ?

·

w/ symptoms of incarcerated hernia

pain/tenderness persist after reduction

·

system toxicity secondary to ischemic bowel

RISK FACTORS
-

increasing age
·

Cigarette smoking
·

controversial : diabetes , parcatitis

,alcohol
ETIOLOGY

got
adenocarahomas in the ductul
epithelina
Raumatic originating
cancers are

resection
(except lymphomas
for all heoplasms and serous cysts)
-NETIC
MUTATIONS ASSOCIATED

oncogene activation
- K-RaS
·

Tumor suppressor gene inactivation -Dp536 p16 APS

·

, ,

their
overexpression of
growth factors or
receptors -EGF receptor
,
HER2/3/4 receptor
hereditary pancreatic cancel :
most important gene - BRCAG
also chance if
you have hereditary pancreatitis
MPTOMS
weight loss jaundice (ictericia) pain /constant epigastre
·

, , , postenos ,

Courvoisier's sign =
palpable nontender gallbladder and painless jaundice
=
MALIGNANCY
DIAGNOSIS
- -

·
CT scan w) contrast
TREATMENT
time
-

evaluate hepatic function and nutrition : Albumin ,

transferrin ,
prealbumin , profrombine
surgery I
head or periampullary lesions
m
ple procedure /panematicduodenectory&
-
·

body and tail lesions as distal panceatectomy splenectory

· bile
resection of the distal common
anastomofic

4
m

epe
complication leakage abcess = sepsis
&
: duct , duodenum , head of pancreas
pancreatic fistulas Reconstruction
Choledochojejunostomy,
:

gastric emptying
diabetes pancreatico ejchostomy , gastrojejunostomy