Ventral ncisional

Hernia
Pathophysiology and Treatment using Component
Separation technique
Patient KS
46 y/o male presents to ER with 1 day
history of hernia with pain, abdominal
contents and inability to reduce it.
Open Nissen Fundoplication 2 years
ago
Easily reducible Ventral Hernia for
some time.
Patient KS
Unable to Vomit due to Nissen
Placement.
NG Tube placed for compression.
Patient able to reduce hernia manually
after NG tube placement and
decompression next morning.
Symptoms improved.
Component separation ventral hernia
repair scheduled for later date.
Patient KS
Obesse
Smoker
History of Diabetes,
Hypercholesterolemia and hyperteion.
bdominal
Hernia
Sac of intra-abdominal organs
or tissue covered in
peritoneum that protrudes
through a defect in the fascia.
Types of Ventral
bdominal Hernias
Congenital
cquired
ncisional
Traumatic
Epidiemology
1,000,000 abdominal wall
herniorrhaphies each year in United
States.
750,000 inguinal hernias
166,000 umbilical hernias
97,000 incisional hernias
25,000 femoral hernias
76,000 miscellaneous hernias
Epidiemology
ncisional Ventral Hernia most common
type.
Mostly defined as hernia that happens
with in one year of index operation.
True incidence is unknown due to
variability in definition.
Major complications of untreated
hernias are unknown
Hernias are mostly treated as soon as
they are found.
Causes of Ventral
ncisional Hernias
Technical
Patient related
Wound related
Genetic
Molecular
Patient Dependent Risk
Factors for ncisional Hernia.
Morbid obesity
bdominal distention
Cigarette smoking
Pulmonary disease
Type 2 diabetes mellitus
Oral anticoagulants
Malnourishment
Hypoalbuminemia
nemia/transfusion
Malignancy
Jaundice

To Fix or not to Fix.

To Fix or not to Fix
Symptomatic
Unsightly bulge, effecting quality of life.
Significant Risk of bowel obstruction.
Risk for not fixing.
Bowel entrapment.
Bowl Necrosis
Bowel Obstruction
Pain
Skin Necrosis/inflammation
How to fix it?
Simple Suture Repair
Mesh Repair
Open
Laparoscopic
Component Separation Repair.
Open
Laparascopic
Component
Sepration
When to use?
Large Hernia
Loss of abdominal domain
Separation of Rectus abd.
Contaminated Hernias.
Failed mesh repair
Recurrent Hernias.
Obese patients.
dvantages over
other methods.
Midline closure
Recreation of Linea lba
Dynamic abdominal wall.
Shestak. Plast Reconstr Surg. 2000 Feb;105(2):731-8
35 Patients with recurrent ventral hernias over 4 year
period. (dibello)
bdominal defects as large as 875 cm sq with
median size of 225 cm sq.
Follow up time of up to 43 months with median time
of 22 months.
Only 8.5% hernia recurrence compared to 28%-45%
in previous studies with other methods.
22 pt's / 4yr period 22 pt's / 4yr period
Defects from 6x10 to 14x24cm Defects from 6x10 to 14x24cm
Causes: removal infected mesh, removal of STSC, Causes: removal infected mesh, removal of STSC,
trauma, abd wall desmoid rsxn trauma, abd wall desmoid rsxn
Complications: 2 wound infections, 1 seroma, 1 Complications: 2 wound infections, 1 seroma, 1
recurrent hernia recurrent hernia
Other studies.
Conclusions:
Complex abdominal hernia repairs are
challenging.
Component separation shows to be a
good technique to reduce the
recurrence rate.
Use of biological Mesh can further
reduce the recurrence rate.
Rutkow IM. Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin
North Am 2003;83:1045-51, v-vi.
Plast. Reconstr. Surg. 98: 464, 1996
SlIdIng |yofascIal Flap of the Fectus AbdomInus |uscles for the Closure of Fecurrent
7entral HernIas