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Incisional Hernia

  1. It occurs through a weak surgical or traumatic wound. It is a type of Ventral Hernia. Usually, the incisional hernia presents as a bulge near a previous wound.
  2. The condition is often asymptomatic but occasionally, presents with pain or strangulation. 
  1. Pathophysiology
    1. Develops in scar of prior laparotomy or drain site
    2. Risks for post-operative hernia development
    3. Vertical scar more commonly affected than horizontal/ Wound infection/ Wound dehiscence/ Malnutrition/ Obesity/ Tobacco abuse/ Presence of drains in wounds/ DM, jaundice, renal failure, immunosuppression/ Malignant disease.  
  2. Incisions commonly affected : 
    1. Lower midline
    2. Subcostal
    3. Lateral muscle splitting incisions
    4. C/F: Like any other hernia. May get obstructed and strangulated.  
  3. Treatment
  1. Smaller incisional hernias (< 3 cm.) can be repaired with primary tissue approximation.
  2. Repair of larger defects generally requires the use of prosthetic materials, which allows for a tension free repair Q. Laparoscopic techniques may also be used. 
  1. Operative
    1. Layer to layer repair - where defect is small to moderate without much tissue loss.
    2. Keel repair (MAINGOT'S) - Scar is excised. The peritoneum and the layers are invaginated into the cavity and successive sutures taken.
    3. Mesh - Used especially with large defects and tissue loss. 
Retraction of External oblique, internal oblique, and transversus abdominis muscles laterally is done during which surgery? (AIIMS May 08)
  1. Laparoscopic kidney surgery approach
  2. Classical exposure of kidney
  3. Lumbotomy for renal cyst
  4. Spigelian hernia repair
Ans. D. Spigelian hernia repair

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