KELAINAN DINDING ABDOMEN,

RONGGA ABDOMEN DAN HERNIA

Taufan Hidayat
HERNIA DIAFRAGMATIKA
OMPHOCHELE
GASTROSCHISIS
HERNIA INSISIONAL
 What is a Hernia?
Congenital or Acquired defect in the abdominal wall
Protrusi atau penonjolan isi suatu rongga melalui defek
atau bagian lemah rongga yang bersangkutan
Herniorrhaphy is one of the most commonly performed
operations in all of surgery
Incidence ~ 1-5%
 Physical Exam Characteristics

Reducible: hernia returns to anatomical location

Incarcerated: fixed hernia +/- intestinal obstruction
Strangulated: s/s of ischemia and obstruction
What factors mitigate hernia formation/enlargement/recurrence?
Weakened tissue
Smoking
Age
Steroids
Immunosuppressive Meds
Collagen disorders
Surgical Wounds
Force applied to tissue
Heavy lifting
Obesity
Constipation
Coughing
Difficulty urinating
Abdominal Wall Anatomy
9 Layers

Skin
Subcutaneous fat
Campers fascia
Scarpas fascia
External Oblique
Internal Oblique
Transversus Abdominus
Transversalis fascia
Peritoneum
 Types
1. Inguinal 10. Gryngelts
2. Femoral 11. Coopers
3. Umbilical 12. Pantaloon
4. Epigastric 13. Richters
5. Sliding 14. Incisional
6. Littres 15. Ventral
7. Internal 16. Hiatal
8. Obturator 17. Parastomal
9. Petits 18. Etc.

What is the most common Type?

 Types
1. Inguinal 10. Gryngelts
2. Femoral 11. Lumbar
3. Umbilical 12. Pantaloon
4. Epigastric 13. Richters
5. Sliding 14. Incisional
6. Littres 15. Ventral
7. Internal 16. Hiatal
8. Obturator 17. Parastomal
9. Petits 18. Etc.

What is the most common Type?

Indirect (50%) >> Direct (25%)
Differential Diagnosis (Inguinal Hernias)

Lymphadenopathy
Varicocele
Undescended testicle
Hematoma/Pseudoaneursym
Sarcoma
Lipoma
What are the management options
for a hernia?
Observation

Support (truss, binder)

Repair
 Inguinal Repairs

Marcy
Bassini
McVay
Shouldice
LICHTENSTEIN
MESH
 Acquired Causes
Increased abdominal pressure
Obesity
Chronic cough
Ascites
Pregnancy
 Incisional Hernias
Up to 11% of pts with previous laparotomy will develop hernia

Previous hernia is a risk for development of future hernia

Chances of successful closure decrease with each successive

repair attempt
 Incisional Hernia Repairs

Repair Recurrence Recurrence Complication

3yr 10yr

Suture 42% 63% 8%

Mesh 24% 32% 17%

Abdominal Wall Reconstruction
T E R I M AK AS I H