This document discusses different types of hernias, including ventral, incisional, and Spigelian hernias. It defines a hernia as an abnormal protrusion of an organ outside its normal cavity. It classifies hernias based on their location, such as inguinal or femoral. Incisional hernias occur through a previous surgical wound. Signs and symptoms vary from a painless lump to a painful, swollen protrusion. Management typically involves surgical repair to excise the hernia sac and close the defect.
Safe Laparoscopic Cholecystectomy Techniques that are discussed here are based on current literature and Evidence Based Medicine guidelines and reviews.
Normally, fistula is defined as an abnormal communication between two epithelized surface.But enterocutaneous fistula is an abnormal communication between the skin with various parts of the gut. The ileum is the most common site of origin of enterocutaneous fistula.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Apollo Hospitals
Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration.
Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open.
With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.
Safe Laparoscopic Cholecystectomy Techniques that are discussed here are based on current literature and Evidence Based Medicine guidelines and reviews.
Normally, fistula is defined as an abnormal communication between two epithelized surface.But enterocutaneous fistula is an abnormal communication between the skin with various parts of the gut. The ileum is the most common site of origin of enterocutaneous fistula.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Apollo Hospitals
Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration.
Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open.
With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.
Prostate cancer for public awareness by DR RUBZDr. Rubz
A presentation prepared for Charity Dinner with Fun Charity. All the profits of the event will go to FReHA (a NGO which supports women's and reproductive health.)
Optingin vs opting out - Malaysian Thoracic Society Dr Hirman Ismail
ABSTRACT
Lung transplant – opting in vs. opting out
Hirman Ismail MD (UKM) MPH (Nottingham)
Transplantation Unit, Medical Development Division
There are many strategies that have been widely discussed and implemented in many countries to increase donor pool and organ transplantation rate. These include among others strengthening central and local organisational structure, establish good transplant/ donor coordinator network, raising public awareness, addressing professional awareness and competencies, incentive (to donor, staff & medical institution), establish mechanism for potential deceased donor identification, ABO incompatible transplant, paired exchange programme, domino transplant, extended donor criteria and regional organ sharing. Legislation has been implicated to be as one of the many ways to improve organ and tissue donation rate in particular through the implementation of opting out system. Opting out system or also known as presumed consent is a system by which consent to donate organ and tissue is presumed unless a person has expressly indicated otherwise during his/her lifetime. Contrary to the opting out system, in opting in system however, consent to donate has to be explicit through verbal or written consent expressed by the donor when he/she was still alive. Legal and ethical barrier in implementing opting out system arises because of the fact that such system would exclude the next of kin from the decision making process when a donor passes away. In Malaysia, the law that governs the authorisation of removal of organ and tissue from a deceased is Human Tissues Act 1974 [Act 130]. Malaysia practices an opting in system as specified in subsection 2(1) of the Act 130 but the final decision to authorise the removal of organ and tissue of the deceased donor rest on the spouse or the next of kin, as specified in subsection 2(2). At the moment, the Ministry is in the process of drafting a new more comprehensive law on transplantation in which the option for possible implementation of opting out system was discussed. Even though it is thought that opting out system may increase donor pool as demonstrated in some countries, the challenges to its implementation is much more complex and shall be tailored to consider local sensitivity, level of awareness/ acceptance and also cultural/ religious values.
Testicular cancer for public awareness by Dr RubzDr. Rubz
A presentation prepared for Charity Dinner with Fun Charity. All the profits of the event will go to FReHA (a NGO which supports women's and reproductive health.)
A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a number of types. Most commonly they involve the abdomen, specifically the groin. Groin hernias are most commonly of the inguinal type but may also be femoral.
Inguinal and femoral hernia:
A hernia is a protusion of a viscus or a part of viscus through and abnormal opening in the walls of its containing cavity. Details of inguinal hernia and few slides on other types of hernia.
Hernias (as an inguinal hernia, umbilical hernia, or spigelian hernia) in which an anatomical part (as a section of the intestine) protrudes through an opening, tear, or weakness in the abdominal wall musculature.
Describes the concept of a surgical abdomen, acute abdominal pain, emergency intervention and approach to management, including the controversial use of analgesic and antibiotics in emergency room.
HIV discrimination among health providers in Malaysia by Dr RubzDr. Rubz
Although doctors took oath that they will treat everyone the best they can and without judging anyone but discrimination still exist especially in HIV affected people. Due to this issue, Pertubuhan Advokasi Masyarakat Terpinggir Malaysia has taken a step to engage with doctors at government sector and desensitize them and find the line to stand together.
Breast Cancer for public awareness by Dr RubzDr. Rubz
A presentation prepared for Charity Dinner with Fun Charity. All the profits of the event will go to FReHA (a NGO which supports women's and reproductive health.)
This is the first phase (qualitative) of the current project we are working on with the supervision of University Malaya and Yale School of Medicine.It will be publish as IBBS 2013 by end of the year. This slide is just a rough picture of what we are doing at the moment. This is copyright protected!
3. Hernia
• Definition
– An abnormal protrusion of an organ or tissue
outside its normal body cavity or restraining
sheath
4. Anatomical structure
Fundus
Covering of
hernia sac
Contents of sac
(usually bowel)
Neck/Mouth
5. Causes of Hernia
• May exploit natural openings(inguinal,femoral and
obturator canals, umbilicus and oesophageal hiatus) or
weak areas caused by stretching, surgical incision or
laparotomy
• Any condition that increases the pressure of the abdominal
cavity may contribute to the formation or worsening of a
hernia.
– Obesity
– Heavy lifting
– Coughing
– Straining during a bowel movement or urination
– Chronic ling disease
– Fluid in the abdominal cavity
– Hereditary
6. Classification of abdominal hernia
Inguinal hernia/Groin hernia
Direct inguinal hernia
Indirect inguinal hernia
Femoral hernia
Ventral hernia
Epigastric hernia
Umbilical hernia
Para-umbilical hernia
Spigelian hernia
Incisional hernia
Other rare and specific interparietal hernia
7.
8. Sign and symptoms
• The signs and symptoms of a hernia can range from
noticing a painless lump to the painful, tender,
swollen protrusion of tissue that you are unable to
push back into the abdomen—possibly a
strangulated hernia.
– Reducible hernia
– Irreducible hernia
– Obstructed hernia
– Strangulated hernia
– Inflammed hernia
9. Reducible hernia
– Asymptomatic reducible hernia
• New lump and the groin or other abdominal wall area
• May ache but is not tender when touched.
• Sometimes pain precedes the discovery of the lump.
• Lump increases in size when standing or when abdominal pressure
is increased (such as coughing)
• May be reduced (pushed back into the abdomen) unless very large
10. Irreducible hernia
– Irreducible hernia
• Usually painful enlargement of a previous hernia that
cannot be returned into the abdominal cavity on its
own or when you push it
• Some may be long term without pain
• Can lead to strangulation
• Signs and symptoms of bowel obstruction may occur,
such as nausea and vomiting
11. Strangulated hernia
– Strangulated hernia
• Irreducible hernia where the entrapped intestine has
its blood supply cut off
• Pain always present followed quickly by tenderness and
sometimes symptoms of bowel obstruction (nausea
and vomiting)
• You may appear ill with or without fever
• Surgical emergency
• All strangulated hernias are irreducible (but all
irreducible hernias are not strangulated)
16. Incisional hernia
• One that occurs through the wound of a
previous operation
• Same features as a hernia that is caused by
non-surgical injury to the abdominal wall
• 1% of transparietal abdominal incisions are
followed by a hernia
17. Aetiology
• A postoperative complication,can be
considered in terms of three factor
– Preoperative factors
– Operative factors
– Postoperative factors
18. Preoperative factors
• Age: older usually need more time to heal
• Malnutrition
• Sepsis: worsen
• Uraemia: inhibit fibroblast division
• Jaundice: impedes collagen maturation
• Obesity
• Diabetes mellitus
• Steroids
• Peritonitis
19. Operative factors
Type of incisions
vertical are more prone to hernia than transverse
Technique and materials
Tension in the closure decrease the blood supply
in wound
Loosen knots
Closure using rapidly absorbable suture materials
Type of operation
Operations involve bowel or urinary tract are
more likely to develop wound infection
Drain tube
20. Postoperative factors
• Wound infection:
– Same important with the wrong choice of suture
material
– Enzyme destruction of healing tissues
– Inflammatory swelling raises tissue tension and impedes
blood supply
– 5-20% of wound infections result in a hernia
• Abdominal distension
– Postoperative ileus increase the tension on a wound
– Stitches may cut out
• Coughing:generates wound tension
21. Signs and symptoms
• A bulge in the scar
• As the hernia enlarges and loculates, symptoms of
subacute I/O are common
• Overlying skin:thin and atrophic,eventually ulcer and
rupture
• Strangulation is a surgical emergency
• P/E:
– Usually reducible
– Hernia with a cough impulse at the site of an old scar
– When the patient lies flat, hernias deceptively small,any
manoeuvre that raise intra-abdominal pressure
produces the hernia in all its glory
22. Management
Even small symptomatic hernias should be repaired early
Prolonged observation simply increase the difficulties of
subsequent repair and hazardous
Surgical technique:same as for para-umbilical hernia
Exicision of the sac after reduction of its contents
Insertion of overlapping sutures into the rectus sheath
23. Spigelian hernia
• Rare but clinically important, less than 1% of total
• An interparietal hernia in the line of the linea
semilunaris(the lateral margin of the rectus sheath)
• Usually at the level of the arcuate line:due to all
aponeurotic layers are reflected anterior to the rectus
muscle
• The hernial sac emerges and enlarges like a mushroom
deep to the external oblique
24. S&S
Symptoms
Local pain that is worse on straining
Lumps
Non-specific lower quadrant discomfort which needs to be
investigated
Features of obstruction or strangulation
Signs:
Tenderness at the site of the hernial orifice
Lump which may be difficult or even impossible to feel
25. Management
• Abdominal USG/CT:useful in the demonstration of these
hernias
• Repair:A simple matter of excising the sac and closing the
defect/Laparoscopic repairs