HEGAZY SURGERY

1. Under supervision of
Prof. Mohamed Abdel salam

2.  An incisional hernia is protrusion of an
organ through the wall in the area of an
old surgical scar.

5. A-straining factors:
1-chronic cough
2-chronic constipation
3-difficulty of micturition(enlarged prostate)
B-General condition:
1-Malnutrition,chronic anaemia and hypoproteinemia.
2-Obesity and old age.
3-General debilitating diseases:e.g D.M,ureamia, liver
cirrhosis.
4- Prolonged steroid therapy and immunosuppressive
drugs.

6. 1-Anaesthetic causes:
*early extubation
*non relaxation of muscles during closure.
2-Long incision or non anatomical position
3-Poor surgical technique:
*rough surgical manipulation with devtalization
muscles
*inappropriate suture material
*inadequate suturing technique

7. 4-Nerve injury with atrophy of muscles:e.g
ilioinguinal nerve injury during appendectomy.
5-Imperfect hemostasis with hematoma
formation and secondary infection.
6-Inadequate closure or closure under tension.

8. 1-Wound infection: the commonest cause of
recurrence
2-Post operative chest infection or complications
3-Prolonged post operative intestinal obstruction.
4-vomitting
5-Early convalescence
6-Heavy work
7-Pregnancy (abdominal distension)

10.  The history of the operation.
 The patient may come presented with one of
the following:
A- asymptomatic: the swelling is the main
complain.
B- symptomatic :he come complain with dull
aching pain beside the swelling.
C- with complication:
1- irreducibility. 3-strangulation.
2- Bowl obstruction. 4-Infection.

11.  The examination done the patient is standing
and lying flat.
1- inspection (incision, swelling, other
abdominal swelling).
2- palpation( swelling, defect, impluse on
cough, tenderness,……)

12.  Done if there is any difficulties in diagnosis.
 1- ultra sound.

13.  2- X-ray with contrast ( herniography )
 3- CT

15. 1/Losing weight.
2/ Strengthening abdominal muscles through
regular moderate exercise such as walking.
3/ Reducing abdominal pressure by avoiding
constipation.
4/ Avoiding undue pressure- Learning to lift heavy
objects in a safe, low-strain way using arm and
leg muscles.
5/Controlling diabetes .
6/ Eating a healthy, balanced diet of whole foods.

16. 1-Palliative:-

17. 2-Operations:- Preparation

18. 2-Operations :-
Techniques
1-Simple
apposition
2-Complex
apposition
3-Plastic
fiber mesh
Open Laparoscopic

19. 2-Operations :-
A ) Simple apposition :-

21. B ) Complex apposition ( herniorrhaphy
):-

22. B ) Complex apposition ( herniorrhaphy
):- 1-Keel repair

23. B ) Complex apposition ( herniorrhaphy
):-

24. C ) Plastic fibre mesh:-

25. C ) Plastic fibre mesh:-

26. C ) Plastic fibre mesh:-

28. Used for repair of large incisional hernias .

31.  Port placement
 Pneumoperitoneum is obtained
 An angled laparoscope is inserted to
assess the extent of adhesions and the
defect.
Laparoscopic Technique:-

32.  adhesiolysis is performed
 It is important to completely expose all
fascial defects
Laparoscopic Technique:-

33.  The extent of the fascial defect is clearly
identified. A dual-sided mesh is cut
 A 2-0 polypropylene or Gortex suture is then
placed in a horizontal mattress fashion
 Skin incisions of 1 mm are made The sutured
are grasped
Laparoscopic Technique:-

34.  The sutures are tied with the knots lying
in the subcutaneous tissue
Laparoscopic Technique:-

35.  The mesh is additionally secured
 The trocars are removed under direct
vision and pneumoperitoneum is released.
 Postoperative collections of serum can be
removed by drainage
Laparoscopic Technique:-

36.  The patient will be observed in a recovery
area for several hours, for monitoring of body
vitals.
 Patients will usually be discharged on the
day of the surgery.if un complicated hernia.
 Antibiotics may be prescribed to help prevent
postoperative infection.

37. 1. Fluid buildup at the site of mesh
placement
2. Postoperative bleeding
3. Prolonged suture pain
4. Intestinal injury
5. Nerve injury
6. Fever
7. Intra-abdominal abcess
8. Urinary retention
9. Respiratory distress

38. Done by:-
 Heba Hamdy 1186
 Heba Ramadan 1187
 Heba Adel 1188
 Heba Abdel Raouf 1189
 Heba Abdel Salam 1190