Sliding inguinal hernia
◼️It result from slippage of the posterior parietal peritoneum on the retroperitoneal structures bringing them to lie in the posterior wall of the hernial sac (figure c shows the caecum slipped down to form the posterior wall of the hernial sac).
◼️It is most common on the left side and almost always in those over 40 years.
◼️It is almost exclusive in men.
◼️This sliding may occur on the right side "Caecum" or on the left side "sigmoid colon" or the bladder on either sides (figure a show part of the bladder sliding in a left inguinal hernia).
◼️Occasionally large intestine is strangulated in an inguinal hernia but usually the non strangulated large bowel is present behind the sac containing strangulated small bowel.
#Surgery
◼️It result from slippage of the posterior parietal peritoneum on the retroperitoneal structures bringing them to lie in the posterior wall of the hernial sac (figure c shows the caecum slipped down to form the posterior wall of the hernial sac).
◼️It is most common on the left side and almost always in those over 40 years.
◼️It is almost exclusive in men.
◼️This sliding may occur on the right side "Caecum" or on the left side "sigmoid colon" or the bladder on either sides (figure a show part of the bladder sliding in a left inguinal hernia).
◼️Occasionally large intestine is strangulated in an inguinal hernia but usually the non strangulated large bowel is present behind the sac containing strangulated small bowel.
#Surgery
What is incarcerated hernia?
Here the contents are fixed in the sac because of their size or adhesions. The hernia is irreducible, but the bowel is not strangulated.
#Surgery
Here the contents are fixed in the sac because of their size or adhesions. The hernia is irreducible, but the bowel is not strangulated.
#Surgery
•What is the current gold standard surgery for hernia repair [hernioplasty]?
-The gold standard current hernia surgery is the Lichtenstein Tension-free Hernioplasty.
-Here approximately 16 × 8 cm size mesh (polypropylene) is placed anterior to the posterior wall after herniotomy and overlapping it generously in all directions including medially over the pubic tubercle.
#Hernia
#Surgery
-The gold standard current hernia surgery is the Lichtenstein Tension-free Hernioplasty.
-Here approximately 16 × 8 cm size mesh (polypropylene) is placed anterior to the posterior wall after herniotomy and overlapping it generously in all directions including medially over the pubic tubercle.
#Hernia
#Surgery
•If the lump does not reduce and does not have a cough impulse, what are the differential diagnoses in incisional hernia?
-Then it may not be a hernia.
-The following differential diagnoses are to be considered:
-Differential diagnoses if it is not reducible
•Deposit of tumor—Desmoid tumor •Hematoma
•Foreign-body granuloma
•Old abscess
•Lipoma.
#Hernia
#Surgery
-Then it may not be a hernia.
-The following differential diagnoses are to be considered:
-Differential diagnoses if it is not reducible
•Deposit of tumor—Desmoid tumor •Hematoma
•Foreign-body granuloma
•Old abscess
•Lipoma.
#Hernia
#Surgery
Remember:
-Aspirin need not be stopped before surgery.
-Thyroid medications should be continued.
-Anti-hypertensives should be continued (even losartan).
-OCPs should be continued till day of surgery.
-Anti-depressants, anti-epileptics, anti-psychotics should be continued except TCA, which should be stopped 3 weeks before surgery due to risk of intra operative arrhythmia.
-Ticlopidine: 14 days before surgery.
-Clopidogrel: 7 days before surgery.
-Warfarin: 3 days before surgery.
-LMWH: 12 hours before surgery.
#Surgery
-Aspirin need not be stopped before surgery.
-Thyroid medications should be continued.
-Anti-hypertensives should be continued (even losartan).
-OCPs should be continued till day of surgery.
-Anti-depressants, anti-epileptics, anti-psychotics should be continued except TCA, which should be stopped 3 weeks before surgery due to risk of intra operative arrhythmia.
-Ticlopidine: 14 days before surgery.
-Clopidogrel: 7 days before surgery.
-Warfarin: 3 days before surgery.
-LMWH: 12 hours before surgery.
#Surgery
Causes of Postoperative FeverDay
2–5 days👉🏼Atelectasis of the lung.
3–5 days👉🏼Superficial and deep wound infection.
5 days👉🏼Chest infection including viral respiratory tract infection, UTI and thrombophlebitis.
>5 days👉🏼Wound infection, anastomotic leakage, intracavitary collections and abscesses.
#Surgery
2–5 days👉🏼Atelectasis of the lung.
3–5 days👉🏼Superficial and deep wound infection.
5 days👉🏼Chest infection including viral respiratory tract infection, UTI and thrombophlebitis.
>5 days👉🏼Wound infection, anastomotic leakage, intracavitary collections and abscesses.
#Surgery
Indications for Open Reduction
NOCAST
-Nonunion
-Open fracture
-Neurovascular Compromise
-Displaced intraArticular fracture
-Salter-Harris3,4,5
-PolyTrauma.
Other indications include:
-Failed closed reduction
-Unable to cast or apply traction due to site.
-Pathologic fractures
-Potential for improved function and/ or out comes with ORIF.
#Surgery
NOCAST
-Nonunion
-Open fracture
-Neurovascular Compromise
-Displaced intraArticular fracture
-Salter-Harris3,4,5
-PolyTrauma.
Other indications include:
-Failed closed reduction
-Unable to cast or apply traction due to site.
-Pathologic fractures
-Potential for improved function and/ or out comes with ORIF.
#Surgery
Among the sources of bleeding, fractures are not to be taken lightly,
-For each rib fracture, blood loss can range from 100-200 mL,
-Tibial fractures can yield 300-500 mL,
-Femoral fractures can produce 800-1000 mL,
-Pelvic fractures may cause loss of more than 2000 mL.
#Surgery
-For each rib fracture, blood loss can range from 100-200 mL,
-Tibial fractures can yield 300-500 mL,
-Femoral fractures can produce 800-1000 mL,
-Pelvic fractures may cause loss of more than 2000 mL.
#Surgery
Sure signs of fracture:
1-Deformity.
2-Length discrepancy.
3-Abnormal movement.
4-Crepitus.
#Surgery
1-Deformity.
2-Length discrepancy.
3-Abnormal movement.
4-Crepitus.
#Surgery
Post-operative return of GI function:
-Small bowel: 12-24h.
-Stomach: 24-48h.
-Large bowel: 48-72h.
#Surgery
-Small bowel: 12-24h.
-Stomach: 24-48h.
-Large bowel: 48-72h.
#Surgery
Stages of bone healing:
1- Hematoma 👉🏼0-3 wk
2-Callus+Osteoclast 👉🏼3-6wk
3-Bone formation in callus 👉🏼6-12wk
4-Cortical gap is bridged by bone 👉🏼6-12 m
5-Remodelling"Normal architecture"👉🏼1-2 yr.
-Tornoto notes
#Surgery
1- Hematoma 👉🏼0-3 wk
2-Callus+Osteoclast 👉🏼3-6wk
3-Bone formation in callus 👉🏼6-12wk
4-Cortical gap is bridged by bone 👉🏼6-12 m
5-Remodelling"Normal architecture"👉🏼1-2 yr.
-Tornoto notes
#Surgery
-Ascitic fluid less than 500 cc cannot be detected clinically.
-Minimal Ascites (500-1000cc).
-Moderated Ascites (1000-2000cc).
-Severe Ascitis (>2000 cc)
•Moderate amount: Shifting dullness.
•Tense: transmitted thrill.
•Minimal: knee - elbow.
#Surgery
-Minimal Ascites (500-1000cc).
-Moderated Ascites (1000-2000cc).
-Severe Ascitis (>2000 cc)
•Moderate amount: Shifting dullness.
•Tense: transmitted thrill.
•Minimal: knee - elbow.
#Surgery
Quick Notes
NON-UNION: -Fracture not united at end of 9 months and there is no progress in fracture healing in last 3 months is Non-union. #Surgery
Types of non-union:
1- Non-union with a gap.
2- Fibrous non-union: F.T. holds the fragments.
3- Hypertrophic non-union: a massive bone around the ends of the
fracture.
4- Atrophic non-union: The bone ends are rounded, narrow osteoporotic.
5- Pseudoarthrosis: is a form of non-union due to formation of an adventitious bursa (i.e. bursa in an abnormal site) between the
sclerosed ends of the fragments with formation of a new joint with a new range of mobility .
#Surgery
1- Non-union with a gap.
2- Fibrous non-union: F.T. holds the fragments.
3- Hypertrophic non-union: a massive bone around the ends of the
fracture.
4- Atrophic non-union: The bone ends are rounded, narrow osteoporotic.
5- Pseudoarthrosis: is a form of non-union due to formation of an adventitious bursa (i.e. bursa in an abnormal site) between the
sclerosed ends of the fragments with formation of a new joint with a new range of mobility .
#Surgery