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Surgical treatment of abdominal wall hernia


Central defect size is divided into: ① small incision hernia: hernia ring maximum distance,[link widoczny dla zalogowanych], (P <3cm; ② in incisional hernia: hernia ring maximum distance, 3cm ≤ (P ≤ 5cm; ③ large incision hernia: hernia ring maximum distance, 5cm < ; <10crn; ④ huge incisional hernia: hernia ring maximum distance, ≥ 10cmo ring under the hernia defect site is divided into: ① midline incision hernia (including umbilical hernia on the midline incision, midline incision below the belly button and down midline incision hernia and umbilical hernia; ② lateral abdominal wall hernia (including costal margin incision hernia, inguinal hernia and incisional hernia between ribs iliac); all kinds of documentation to include part time, specific location, medium and small size of type and number of defects. specifically listed below : umbilical hernia is small (2.5cm); or umbilical, down the middle of a large incisional hernia (8cm); or under the costal margin in the lateral abdominal wall hernia (4ClTI); or lateral abdominal wall incisional hernia between ribs iliac (13cm ) and so on. Treatment of incisional hernia: abdominal wall hernia can not heal, required surgery to cure. to the poor general condition, heart and lung failure, or have other medical complications should be actively preparing for when the timing of surgery after the selection. surgical timing: on no incision the early history of hair infection and recurrent hernia incisional hernia, wound healing suggested that 3 to 6 months after repair; on the early history of a wound infection and recurrent hernia fat hernia, it is recommended infection control and wound healing 1 year after repair; have repair materials have received the infection recurrent hernia repair in wound healing should be 1 year later repair, and recommended surgery again to take the original infection of the incision before the subcutaneous tissue for bacterial culture, such as new materials for the negative patch is available, such as the use of antibiotics for the positive treatments. be negative after surgery. associated with contaminated wound incisional hernia repair using direct suture. If a large defect that can be used autologous tissue transplantation or repair with absorbable artificial materials. wound contamination is not heavy, you can fully prepare for the next use of preoperative polypropylene mesh repair, do not fix PTFE and its composites. emergency surgery while in principle the use of non absorbent material incisional hernia repair. Surgical Methods: ① small incision hernia: Recommended line l 10 of the Prolene closed loop continuous suture hernia defect, the incision with suture length ratio of the length and preferably 4:1; ② in incisional hernia: can direct suture, but interference in the pull tension on the joint organization, the need to repair the materials used; ③ Japanese giant incisional hernia: the best use of materials, repair. perioperative management include the following. preoperative preparation: an active treatment in patients with incisional hernia associated with systemic diseases. rigorous testing respiratory function, including: routine chest X-ray examination and lung function test and blood gas analysis. For those with respiratory insufficiency should be fully prepared: Before doing the preparation of giant incisional hernia were very important. lung infection, preoperative antibiotics, infection control 1 week after surgery. Take a deep breath and chest by the diaphragm Lian Duan. smoker to stop smoking 2 weeks before surgery. in giant incisional hernia, to prevent the material is also satisfied abdominal hernia after abdominal compartment syndrome and respiratory failure (Ab-dominalcompartmentsyndrome), preoperative abdominal cavity and abdominal expansion should be carried out compliance training. can be 2 to 3 weeks before surgery the beginning of the abdominal hernia contents also satisfied with cummerbund belly banding. In the early banding, should be closely observed in patients with respiratory function and prevent sudden respiratory failure. the first week should be separated from Et 3d line gas analysis and determination of lung function 1. after 2 weeks according to the patient's condition, appropriate to extend the detection time. for 2 to 3 weeks later, the patient's lung function and blood gas analysis meet the above criteria can be surgery. the use of preoperative antibiotic prophylaxis: prophylactic antibiotics can reduce the infection rate of incisional hernia, especially the elderly, diabetes, immune function, large or multiple complex incisional hernia, the use of large biological materials, repair and wound bacterial contamination of the digestive tract may be subjected to prophylactic antibiotics routinely. postoperative treatment: ① postoperative antibiotics should be used 2 ~ 3d, or according to patient circumstances. ② to ensure the smooth and non-closed drainage bacteria. According to drainage (drainage volume is less than l0ml / d) within 3 ~ 5d postoperative drain removal. surgical wound large. drain for a long time, may be appropriate to extend the time to extubation. In addition to drain after the allocation of attention locally still No fluid accumulation of blood. that fluid accumulation of blood to keep pumping. ③ body temperature changes after attention and often see the wound, if the temperature continued to rise after surgery and wound redness, to be alert to the occurrence of wound infection, antibiotics should be given , and the importance of local treatment. ④ early postoperative activities of patients in bed, 2 ~ 3d after walk with. after use athletic compression banding for 2 weeks and continue to use athletic 3 to 6 months. Postoperative 3 to 6 months, banning all physical activity and heavy physical labor. (Lee Foundation MA Chapter Song written by)