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Hernia
Repair
What is
Hernia Repair?
Lumbar
herniae have been classified as congenital or
acquired and aetiologically as spontaneous or
post traumatic and postoperative incisional.
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Effects
of Hernia Repair
The
goal of hernia repair is to eliminate the defect
and to construct an elastic and firm abdominal
wall that will withstand the stresses of daily
life.
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Candidates for Hernia Repair
The
patient presents with a "lump in the flank"
associated with a dull, heavy, pulling feeling.
Diagnosis is confirmed by the presence of
reducible, often tympanic mass in the flank when
the patient is erect.
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Your Consultation
History and physical examination axiomatically
are the best means of diagnosing hernias.
Associated conditions such as ascites,
constipation, obstructive uropathy, chronic
obstructive pulmonary disease, or cough are
carefully sought in the review of systems.
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The
Hernia Repair Procedure
A wide
variety of techniques have been described for
repair of lumbar hernias. These include closure
of the fascial defect with nonabsorbable
sutures, overlapping of the aponeuroses, fascial
rotation flaps and free fascia lata grafts.
Hafner and colleagues have reinforced large
defects of the inferior lumbar triangle using
Marlex mesh. Laparoscopic approach has been used
in the repair of uncomplicated lumbar hernias.
The surgical treatment of lumbar hernias is
performed through an oblique incision. The
preperitoneal fat adjacent to the hernia sac
should be carefully inspected because it may
represent mesocolon with associated blood
supply. The paraperitoneal sliding component of
the sac should be inverted and plicated avoiding
the blood supply of the viscus. When a sac is
present it should be opened and its contents
identified. This helps in evaluating the anatomy
of a sliding component and to identify a
multilocular sac.
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Recovery
Many
patients are managed through surgical daycare
centers, and are able to return to work within a
week or two, while heavy activities are
prohibited for a longer period.
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Risks
Surgical complications have been estimated to be
up to 10%, but most of them can be easily
addressed. They include surgical site
infections, nerve and blood vessel injuries,
injury to nearby organs, and hernia recurrence.
Frequently Asked Questions
Q:
What is a lumbar hernia?
A:
Lumbar
hernia is a protrusion between the last rib and
the iliac crest where the transverse muscle is
covered by the latissimus dorsi. The lumbar
hernia must be differentiated from abscesses,
haematomas, soft tissue tumours, renal tumours
and muscle strain. Lumbar hernias increase in
size and should be repaired when found. Nearby
fascia is mobilised and the hernial defect
obliterated by precise fascia-to-fascia closure.
The recurrence rate is low.
Q:
Where does lumbar hernia occur?
A:
Lumbar herniae are through the posterior
abdominal wall at some level in the lumbar
region. The most common sites (95%) are:
·
superiorly - Grynfeltt's triangle
·
inferiorly - Petit's triangle
Q:
What might happen if lumbar hernia is not
treated?
A:
Lumbar hernias rarely result in strangulation
and hence the prognosis is good. These hernias
increase in size and eventually become
symptomatic. The corrective surgical procedure
becomes more complex as the hernial defect
becomes larger. Reconstruction is the
challenging aspect of lumbar hernia surgery.
Q: What is Petit's
hernia?
A:
Petit's hernia is
the one that protrudes through
lumbar triangle.
This triangle lies in the posterolateral
abdominal wall bounded in front by free margin
of
external oblique muscle, behind by
latissimus dorsi and below by
iliac crest. The neck (place where a
hernia protrudes into the opening) is large, so
chances of
strangulating are small.
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