WordNet

a depression scratched or carved into a surface (同)scratch, prick, slit, dent
the cutting of or into body tissues or organs (especially by a surgeon as part of an operation) (同)section, surgical incision
rupture in smooth muscle tissue through which a bodily structure protrudes (同)herniation

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〈U〉切り込むこと,刻み込むこと
ヘルニア,脱腸

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/10/21 12:14:29」(JST)

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An incisional hernia is a type of hernia caused by an incompletely-healed surgical wound. Since median incisions in the abdomen are frequent for abdominal exploratory surgery, ventral incisional hernias are often also classified as ventral hernias due to their location. Not all Ventral Hernias are from incisions, as some may be caused by other trauma or congenital problems.

Etiology

Incisional hernias are usually caused by a weakness of the surgical wounds, which may be caused by haematoma, seroma, or infection, all of which result in decreased wound healing. They may also be caused by increased intra abdominal pressure due to a chronic cough (as in COPD), constipation, urinary obstruction (as in BPH), pregnancy, or ascites. They can also result from poor surgical technique.

Signs and symptoms

Clinically, incisional hernias present as a bulge or protrusion at or near the area of a surgical incision. Virtually any prior abdominal operation can develop an incisional hernia at the scar area (provided adequate healing does not occur due to infection), including large abdominal procedures such as intestinal or vascular surgery, and small incisions, such as (appendix removal or abdominal exploratory surgery). While these^[which?] hernias can occur at any incision, they tend to occur more commonly along a straight line from the xiphoid process of the sternum straight down to the pubis, and are more complex in these^[which?] regions. Hernias in this^[which?] area have a high rate of recurrence if repaired via a simple suture technique under tension. For this reason, it is especially advised that these be repaired via a tension free repair method using a synthetic mesh.

Treatment

Traditional "open" repair of incisional hernias can be quite difficult and complicated. The weakened tissue of the abdominal wall is re-incised and a repair is reinforced using a prosthetic mesh. Complications, particularly infection of the incision, frequently occur because of the large size of the incision required to perform this surgery. A mesh infection after this type of hernia repair most frequently requires a complete removal of the mesh and ultimately results in surgical failure. In addition, large incisions required for open repair are commonly associated with significant postoperative pain. Reported recurrence rates after open repair are up to 20%^[1]^[2] and influenced by mesh size and fixation type.^[3]^[4]^[5]^[6]

Laparoscopic incisional hernia repair is a new method of surgery for this condition.^[7]^[8]^[9] The operation is performed using surgical microscopes and specialized instruments. The surgical mesh is placed into the abdomen underneath the abdominal muscles through small incisions to the side of the hernia. In this manner, the weakened tissue of the original hernia is never re-incised to perform the repair, and one can minimize the potential for wound complications such as infections. In addition, performance of the operation through smaller incisions can make the operation less painful and speed recovery. Laparoscopic repair has been demonstrated to be safe and a more resilient repair than open incisional hernia repair.

External links

Melbourne Hernia Clinic

References

^ Park, E; Roth, JS (2006). "Abdominal Wall Hernia". Curr Prob Surg. 43 (5): 326–75. doi:10.1067/j.cpsurg.2006.02.004. PMID 16679124.
^ Bucknall, TE; Cox, PJ; Ellis, H (1982). "Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies". Br Med J. 284 (6320): 931–3. doi:10.1136/bmj.284.6320.931. PMID 6279229.
^ Edwards, C; Geiger, T; Bartow, K; et al. (2009). "Laparoscopic transperitoneal repair of flank hernias: a retrospective review of 27 patients". Surg Endosc. 23: 2692–6. doi:10.1007/s00464-009-0477-4. PMID 19462203.
^ Schumpelick, V; Klinge, U; Junge, K; Stumpf, M (2004). "Incisional abdominal hernia: the open mesh repair.". Langenbecks Arch Surg. 389: 1–5. doi:10.1007/s00423-003-0352-z. PMID 14745557.
^ Lyons, M; Mohan, H; Winter, DC; Simms, CK (2015). "Biomechanical abdominal wall model applied to hernia repair". Br J Surg. 102 (2): e133–9. doi:10.1002/bjs.9687. PMID 25627126.
^ Sharma, A; Dey, A; Baijal, M; Chowbey, PK (2011). "Laparoscopic repair of suprapubic hernias:transabdominal partial extraperitoneal (TAPE) technique". Surg Endosc. 25: 2147–52. doi:10.1007/s00464-010-1513-0. PMID 21184109.
^ Bingener, J; Buck, L; Richards, M; Michalek, J; Schwesinger, W; Sirinek, K (2007). "Long term Outcomes in Laparoscopic vs Open Ventral Hernia Repair". Arch Surg. 142 (6): 562–7. doi:10.1001/archsurg.142.6.562. PMID 17576893.
^ Nguyen, SQ; Divino, CM; Buch, KE; Schnur, J; Weber, KJ; Katz, LB; Reiner, MA; Aldoroty, RA; Herron, DM (2008). "Postoperative Pain After Laparoscopic Ventral Hernia Repair: a Prospective Comparison of Sutures Versus Tacks". Journal of Society of Laparoendoscopic Surgery. 12 (2): 113–6. PMC 3016187. PMID 18435881.
^ LeBlanc, KA. (2005). "Incisional hernia repair: Laparoscopic techniques". World Journal of Surgery. 29 (8): 1073–9. doi:10.1007/s00268-005-7971-1. PMID 15983711.

UpToDate Contents

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1. 瘢痕ヘルニア incisional hernia
2. 成人における腹壁ヘルニアの概要 overview of abdominal wall hernias in adults
3. 広範囲または合併性の腹壁欠損に対するcomponent separation法による修復 component separation repair of large or complex abdominal wall defects
4. 開腹術の合併症 complications of abdominal surgical incisions
5. 腹壁閉鎖の原則 principles of abdominal wall closure

English Journal

Prevention of Incisional Hernias by Prophylactic Mesh-augmented Reinforcement of Midline Laparotomies for Abdominal Aortic Aneurysm Treatment: A Randomized Controlled Trial.

Muysoms FE1, Detry O, Vierendeels T, Huyghe M, Miserez M, Ruppert M, Tollens T, Defraigne JO, Berrevoet F.
Annals of surgery.Ann Surg.2016 Apr;263(4):638-45. doi: 10.1097/SLA.0000000000001369.
BACKGROUND: The incidence of incisional hernias after abdominal aortic aneurysm repair is high. Prophylactic mesh-augmented reinforcement during laparotomy closure has been proposed in patients at high risk of incisional hernia.METHODS: A multicenter randomized trial was conducted on patients underg
PMID 26943336

Laparoscopic repair of complex ventral hernia facilitated by pre-operative chemical component relaxation using Botulinum Toxin A.

Elstner KE1,2, Jacombs AS3, Read JW4,5, Rodriguez O2, Edye M1,6, Cosman PH1,2, Dardano AN7, Zea A2, Boesel T1, Mikami DJ8, Craft C1, Ibrahim N9,10,11.
Hernia : the journal of hernias and abdominal wall surgery.Hernia.2016 Apr;20(2):209-19. doi: 10.1007/s10029-016-1478-6. Epub 2016 Mar 7.
PURPOSE: The operative management of complex ventral hernia poses a formidable challenge, despite recent advances in surgical techniques. Recurrence rates after complex ventral hernia repair remain high, and increase with each failed attempt. This study examines the effect of pre-operative abdominal
PMID 26951247