1. HERNIA

2. DEFINITION

3. HERNIA TYPES Primary Incisional

4. HERNIA Types – Primary Indirect Direct Femoral Spigelian Epigastric Lumbar: Sup.(Grynfeltt’s): Inf.(Petit’s) Obturator Richter’s Sliding

5. HERNIA TYPES Primary Incisional

6. HERNIA Types – Incisional Midline Sternotomy Trocar Site Parastomal Lumbar

7. HERNIA Incisional Hernias – Etiologic Factors Surgeon

8. HERNIA Incisional Hernias –Etiologic Factors Surgeon Infection Tension Exercise Obesity Ascites Smoking and Chronic Cough Steroids Malnutrition Advanced Age Diabetes Collagen Disorders

9. HERNIA Indications for Repair

10. HERNIA Indications for Repair Strangulation Incarceration Local Symptoms Patient Preference Extenuating Circumstances Travel Insurance Work

11. HERNIA Repairs Open Primary Mesh Laparoscopic TAPP TEP

12. HERNIA Repairs Open Primary Non-absorbable suture Absorbable suture Separation of components technique Mesh Laparoscopic

13. HERNIA Repairs Open Primary – Types Bassini McVay Halstead Shouldice Nyhus-Condon Mesh Laparoscopic

14. HERNIA Repairs Open Primary Mesh – Types Lichtenstein Plug and Patch Kugel Stoppa Laparoscopic

15. HERNIA Repairs Open Primary Mesh Polypropylene ePTFE Dual Composites Biologic Laparoscopic

16. HERNIA Repairs Open Primary Mesh – Technical Issues Overlay/Underlay Smooth Seating Fixation Sutures Tacks Adhesion Laparoscopic

17. HERNIA Repairs Open Primary – Complications Recurrence Infection Bleeding Nerve Injury Seroma Mesh Laparoscopic

18. HERNIA Recurrent Hernias – Etiologic Factors Surgeon Missed direct, indirect, or femoral component Inadequate medial closure Inadequate dissection of the sac Inadequate closure of the internal ring

19. HERNIA Repairs Open Primary Mesh – Complications Recurrence Infection Bleeding Nerve Injury Seroma Adhesions Fistula Bulk Laparoscopic

20. HERNIA Repairs Open Primary Mesh Laparoscopic – Complications Recurrence Infection Bleeding Nerve Injury Seroma Adhesions Intestinal Injury Fistula

21. HERNIA Potentially Injured Nerves Ilio-inguinal Ilio-hypogastric Genitofemoral Femoral Obturator

22. HERNIA Laparoscopic vs. Open Consensus Advantages Bilateral hernias Recurrences of open repairs Femoral hernias Debatable Advantages Recurrence rate Comfort Return to normal activities Negatives Cost to hospital Learning curve Unknowns Infection rate Chronic pain