Incisional

Dr. Perez Martin

Hosp. Guest
Concept
• From the Latin: ex, out and venter, meaning belly, protruding abd visors • Thi
s should occur in a place where no weak spot or hole preexists natural • Differe
nce hernias
Defects of the anterior abdominal wall
• • • • Diastasis Laparocele bossing or "bulge" Eventration
• • • • Post traumatic laparotomy Post Post Post sepsis resection of cancer
Healing Concepts
• Two groups in the restoration of any solution of continuity tis:
- Inherent to the patient:
• Condition psychophysical • Stress • Normoalimentación
- Inherent to the external environment
• Dependent surgeon
- Maneuvers, hemostasis, suture tension etc.
• Dependents of the wound
- Cont bacterial, trauma to the wound, associated enf
Factors involved in the repair
• • • • Inflammation Metabolism of collagen contraction epithelialization
Chronology in the healing
• First 18 hours influx of PMN • At 48 pm ↑ of macrophages and replaced by fibro
blasts • At the 4th day colagenogénica repair and start the contraction phase •
15 days the wound is repaired • 5th week at 3 months ↑ contraction phase gradual
ly gives way to the 6th month • The tensile strength and strain to normal year
Classification
Acute open or closed immediately eviscerated simple 1st grade 2nd grade 3rd grad
e 2nd grade 1st grade eventration or mediate Chronicle
Primary Secondary
Acute eventration
• Synonyms:
- Postoperative eventration - burst or rupture abdominal dehiscence - Spontaneou
s Evisceration
• By convention it is considered that may appear in the corresponding period to
30 days after the surgery • Higher incidence in sex masc 2.8 / 1 • Occurs in all
ages with a prevalence between 50 and 60 • Absolute frequency between 0.3 and 3
% of abdominal operations
causes
• Preoperative:
- Factors ↑ abdominal pressure "bronchopulmonary Pathology" urinary tract pathol
ogy "Obesity - homeostatic" thrombocytopenia "Anemia, hypoproteinemia" Diabetes,
uremia, vitamin deficiencies - Immune System Disorders »Leukopenia» AIDS
causes
• Operative:
- Surgical technique
• Incision • Summary • suture material
- Time-operative - Wake anesthetic
• Rigging resp tract cleaning • Anticipating at closing
causes
• Post operative:
- Abdominal distension
• Ileus
- Paralytic - Mechanical
• Globe bladder etc.
- Surgical wound infection
classification
Acute open or closed immediately eviscerated simple 1st grade 2nd grade 3rd grad
e 2nd grade 1st grade eventration
Open evisceration
• Simple or retained:
- The viscera are kept in the background with no tendency to cross the plane of
the peritoneum
• With evisceration:
- Guts and / or the omentum out of the abdominal cavity (Finochietto)
• First degree: not reach the level of the skin • Second level: a sector of the
diameter visceral than cutaneous cover • Third degree: exceeds the mesenteric bo
rder of the skin line
classification
• Cover Type I
- The skin on TCS and peritoneum are undamaged
• Cover type II:
• Only the skin is free,
clinic
• Covers can be oligosymptomatic or asymptomatic • The early onset of a chronic
hernia is usually the result of this prolonged episode • State sub-fever, tachyc
ardia, discomfort in the scar and abdominal strain resistant to treatment should
raise suspicion of a cover eventration • Tale of a clear noise or tearing sensa
tion accompanied by pain • Drainage of serous fluid, pink salmon in the wound
clinic
• • • • • • • Inspection Auscultation Percussion Palpation Rx Ultrasound CT
complications
• Systemic
- Hydro electrolyte imbalance - Sepsis
• Local
- - - - - Infection wall Strangulation intestinal obstruction intestinal bleedin
g fistula
treatment
• Covers:
- Expectant - Surgical
• Open
- Grade I and II
• With infection • No infection
Chronic Eventrations
Eventration is called chronic disruption of the abdominal wall through a hole un
natural, after the 30 days of its synthesis
classification
Umbilicopubiana Xifoumbilical or higher or lower midline of the cord or half or
full Xifopubiana
(Sibilla)
Lateral quadrant
right
Lower Higher Lower Higher
left
posterolateral
costolumboilíaca
classification
topographic supraubmilicales infraumbilical suprainfraumbilicales
(Garritz and Gonzalez)
Median lateral paramedian
Complicated recurrent complex Eventrations Pericolostómicas neighboring bones
Classification
Epigastric suprainfraumbilicales infraumbilical Supraubilicales vertical transve
rse or oblique hypogastric paraumbilical
Barrotaveña
Lateral paramedian Medium
Superior lateral posterolateral lower Paraubilicales costolumboilíacas
classification
Depending on the size
small
Up to 2 cm in diameter cross support
moderate
Of 2-5 cm
large
Of 5-10 cm
giants
Over 10 cm
Predisposing factors
Relationships with patients
Age-sex Hypoproteinemia Hipoascorbinemia Anemias-hypovolemia Malignancies Obesit
y Diabetes Drug Allergy-irradiation immunity
Anesthesia
Related to the operation
Tactics and surgical incision suture material Drainage
Related Disease
infections
Triggers
Increased abdominal pressure
Increase in the
Vomiting Cough dyspnea ileus Ascites
Increased muscle tone parietal
diagnosis
• • • • • • • Inspection Interrogation TAC Ultrasound Palpation Auscultation Rx
treatment
• Notions of pneumoperitoneum GoñiMoreno • Notions of parietal prosthesis use on
tummy • Notions • Notions of laparoscopic eventroplstias