Hernias de la pared abdominal
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Transcript of Hernias de la pared abdominal
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HERNIAS DE LA PARED ABDOMINAL
Fernando Jiménez Medina RICG
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HERNIAS DE LA PARED ABDOMINAL
Definición:› La palabra hernia proviene de un vocablo
latino que significa rotura.
› Protrusión de estructuras abdominales a través de un orificio de la pared abdominal contenidas en un saco herniario.
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HERNIAS DE LA PARED ABDOMINAL
1. Orificio en Pared Abdominal
2. Contenido de una cavidad que protruye a través del orificio
3. Formación de Saco Herniario
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HERNIAS DE LA PARED ABDOMINAL
› Epigástricas› Umbilicales› Inguinales› Crurales› De Spiegel› Lumbares› Incisionales
Hernias Abdominales Anteriores
hernia.tripod.com/types.html 2005 Grant’s Atlas
linea alba
ombligo
linea semilunar
Anillo inguinal superficial
canal femoral
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HERNIAS DE LA PARED ABDOMINAL
Hernia Umbilical
› Común Adultos› 6% Hernias de Pared Abdominal en Adultos
en USA› 30% plastias del IMSS en el 2006
Data Mart: Estadísticas Médicas del IMSS. México: IMSS 2006
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HERNIAS DE LA PARED ABDOMINAL
Hernia Umbilical› Factores de Riesgo
Embarazos repetidos Obesidad Ascitis Tumores intracavitarios Estreñimiento crónico Ejercicios físicos extremos
Tratado de Cirugía General. Asociación Mexicana de Cirugía General; 2ª Ed
PRESION INTRAABDOMINAL
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HERNIAS DE LA PARED ABDOMINAL
HERNIA UMBILICAL
Mujer (3 a 5) Sobrepeso 35-50 años
SÍNTOMAS:Asintomática 39%Dolor al esfuerzo físico 61%Abultamiento
1. Epiplón2. Colón3. Intestino
Delgado
CUADRO CLINICO
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HERNIAS DE LA PARED ABDOMINAL
Hernia Umbilical› DIAGNÓSTICO
Dolor relacionado con una “masa que sale y entra de la cicatriz umbilical”
Pacientes Obesos TAC
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HERNIAS DE LA PARED ABDOMINAL
Hernia Umbilical› TRATAMIENTO
Siempre Quirúrgico
Mejor Técnica Reparación Primaria 11% Técnica Mayo 10-30% Recurrencia Reparación con malla 3% >2cm Reparación Laparoscópica Reparación con Prolene Hernia System (PHS)
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HERNIAS DE LA PARED ABDOMINAL
Hernia Umbilical
› TRATAMIENTO Antibióticos Profilácticos
Discreta disminución de la incidencia de infecciones de la herida quirúrgica
Sin relevancia Estadística
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HERNIAS DE LA PARED ABDOMINAL
Hernia Umbilical› Complicaciones Posoperatorias
1. Hematoma2. Seroma3. Infección4. Rechazo de la Malla5. Recidiva6. Infección Profunda y tardía
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HERNIAS DE LA PARED ABDOMINAL
Minerva Anestesiol. 2011 Apr;77(4):457-62.Surgical management of abdominal compartment syndrome.
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HERNIAS DE LA PARED ABDOMINAL
Incarceración Obstrucción Estrangulamiento
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HERNIAS DE LA PARED ABDOMINAL
Polipropileno Poliester
› Flexibilidad› Fibroblástos› 12% o > Infección
Politetrafluoroetileno› 1 CARA
Suave, Microporos, Resistente al crecimiento tisular
› 2 Cara Áspera, Macroporos,
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HERNIAS DE LA PARED ABDOMINAL
Técnica Mayo› Recurrencia a los 10 años 54%
Shackelford's Surgery of the Alimentary Tract, 6th ed.
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HERNIAS DE LA PARED ABDOMINAL
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HERNIAS DE LA PARED ABDOMINAL
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HERNIAS DE LA PARED ABDOMINAL
Polipropileno 0Nylon 0Puntos separados
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HERNIAS DE LA PARED ABDOMINAL
HERNIA EPIGÁSTRICA› Inusual› Incidencia 1-10%› Asintomáticas› Hombres 5› 20-40 años› 20% Multiples
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HERNIAS DE LA PARED ABDOMINAL
HERNIA EPIGÁSTRICA› Diagnóstico
Dolor en parte superior de abdomen Esfuerzo físico Tos Hipo Remite con el Reposo
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HERNIAS DE LA PARED ABDOMINAL
HERNIA EPIGÁSTRICA Tratamiento
› Siempre Quirúrgico Reparación Primaria 2cm Reparación con malla > 2cm Reparación Laparoscópica en Defectos
Grandes y Múltiples
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HERNIAS DE LA PARED ABDOMINAL
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HERNIAS DE LA PARED ABDOMINAL
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HERNIAS DE LA PARED ABDOMINALH
ern
ia In
gu
inal
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HERNIAS DE LA PARED ABDOMINAL
HERNIA INGUINALEPIDEMIOLOGIA:
› 75%› 95%› 9 > ♂› 700,000
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HERNIAS DE LA PARED ABDOMINAL
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HERNIAS DE LA PARED ABDOMINAL
HERNIA INGUINAL› Clasificación Anatómica
Triángulo deHesselbach
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HERNIAS DE LA PARED ABDOMINAL
HERNIA INGUINAL› Clasificación Anatómica
HERNIA INDIRECTA
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HERNIAS DE LA PARED ABDOMINAL
ANATOMIA
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HERNIAS DE LA PARED ABDOMINAL
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HERNIAS DE LA PARED ABDOMINAL
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HERNIAS DE LA PARED ABDOMINAL
CANAL INGUINAL
•SUPERIOR• Oblicuo Interno
•INFERIOR• Ligamento Inguinal
•ANTERIOR• Aponeurosis del OM
•POSTERIOR• Fascia Transversalis• Aponeurosis Transverso
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HERNIAS DE LA PARED ABDOMINAL
CORDON ESPERMÁTICO
•Cremaster•Vasos Testiculares•Nervio Genitofemoral•Conducto Deferente•Vasos del Cremaster
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HERNIAS DE LA PARED ABDOMINAL
HERNIAS INGUINALES› Manifestaciones Clínicas
Asintomática
Peritonitis por Estrangulamiento
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HERNIAS DE LA PARED ABDOMINAL
HERNIA INGUINAL› Clasificación
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HERNIAS DE LA PARED ABDOMINAL
CLASIFICACIÓN DE LLOYD M. NYHUS (1991)› Tipo I. Hernia inguinal indirecta con anillo
profundo normal.
› Tipo II. Hernia indirecta con anillo profundo dilatado, vasos epigástricos no
desplazados y pared posterior intacta.
Carbonell TF:clasificación.http://www.cirugest.com/revisiones/cir12-04/12-04-04.pdf
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HERNIAS DE LA PARED ABDOMINAL
CLASIFICACIÓN DE LLOYD M. NYHUS (1991)
Tipo III. Defectos de la pared posterior.› A). Hernia Inguinal directa.› B). Hernia inguinal indirecta con:
- Anillo profundo muy dilatado. - Vasos epigástricos desplazados - Destrucción de la fascia transversalis.
Carbonell TF:clasificación.http://www.cirugest.com/revisiones/cir12-04/12-04-04.pdf
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HERNIAS DE LA PARED ABDOMINAL
CLASIFICACIÓN DE LLOYD M. NYHUS (1991)
Tipo IV. Hernia recurrente.
› A). Hernia recurrente directa.› B). Hernia recurrente indirecta.› C). Hernia recurrente femoral.› D). Hernia recurrente combinada
Carbonell TF:clasificación.http://www.cirugest.com/revisiones/cir12-04/12-04-04.pdf
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HERNIAS DE LA PARED ABDOMINAL
CLASIFICACION DE ARTHUR J. GILBERT (1989)› Está basada en conceptos anatómicos y
funcionales establecidos en el transoperatorio. 1. Presencia o ausencia de saco herniario. 2. Tamaño y competencia del anillo profundo. 3. Integridad de la fascia transversalis en el
triángulo de Hesselbach.
Carbonell TF:clasificación.http://www.cirugest.com/revisiones/cir12-04/12-04-04.pdf
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HERNIAS DE LA PARED ABDOMINAL
CLASIFICACION DE ARTHUR J. GILBERT (1989)› Tipo 1: Anillo profundo normal y presencia de saco
indirecto
› Tipo 2: Anillo profundo dilatado no más de 4 centímetros y presencia de saco indirecto.
› Tipo 3: Anillo profundo dilatado con componente de deslizamiento o inguinoescrotal y vasos epigástricos desplazadosCarbonell TF:clasificación.http://www.cirugest.com/revisiones/cir12-04/12-
04-04.pdf
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HERNIAS DE LA PARED ABDOMINAL
CLASIFICACION DE ARTHUR J. GILBERT (1989)
› Tipo 4: Destrucción del piso del conducto inguinal. Anillo inguinal profundo de diámetro normal.
› Tipo 5: Defecto diverticular de la pared posterior no mayor de 2 cm, generalmente suprapúbica.
Carbonell TF:clasificación.http://www.cirugest.com/revisiones/cir12-04/12-04-04.pdf
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HERNIAS DE LA PARED ABDOMINAL
Modificada en 1993 por Rutkow y Robbins añadiendo dos nuevas categorías
› Tipo 6: Hernia mixta o en Pantalón› Tipo 7: Hernia Crural
Carbonell TF:clasificación.http://www.cirugest.com/revisiones/cir12-04/12-04-04.pdf
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HERNIAS DE LA PARED ABDOMINAL
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HERNIAS DE LA PARED ABDOMINAL
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El que aprende y aprende y no practica lo que sabe, es como el que ara y ara y no siembra.
Platón (Atenas, 427 a C.- 347 a.C)
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