الفهرس 
Anatomy of the Anterior Abdominal WallOnly 14 pages are availabe for public view
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Abstract
V
entral hernias represent the defects in the fascial and muscular layers of the abdominal wall which intra-abdominal contents can protrude. Ventral hernias may be primary or secondary. Primary ventral hernias occur spontaneously due to primary fascial pathology, and include umbilical, epigastric, spigelian, lumbar and other hernias.
Secondary hernias typically occur after surgical incisions and are therefore termed incisional hernias. Incisional hernias are common complication following abdominal surgery and develop in 3-13% of laparotomy incisions. Those hernias may develop through deterioration of the abdominal muscular layers or they may develop from failed healing of an anterior abdominal wall surgical incision.
Patient-related factors linked to ventral hernia formation include obesity, older age, male gender, sleep apnea, emphysema, and prostatism. It has been proposed that the same factors associated with destruction of the collagen in the lung result in poor wound healing with increased hernia formation. Also wound infection has been linked to hernia formation.
A wide range of surgical procedures have been developed for ventral hernia repair. Tension-free repair is one of the key concepts in hernia surgery. The repair may be direct suturing or use of prosthetic mesh using the open or laparoscopic technique. Prosthetic mesh and tension free repair has revolutionized the repair of ventral hernias resulting in decrease in recurrence rates.
The laparoscopic approach is an increasingly used alternative method for repair of ventral hernias. The repair generally is performed intra-abdominally and involves placement of intraperitoneal mesh prosthesis to cover the hernia defect.
Early results show that the technique is safe, simple, and effective, with results that are better than or equivalent to the results of open repair. Length of hospital stays and pain medication requirements are less than with open repair. Use of the laparoscopic technique was associated with statistically fewer wound complications, fewer overall complications and a lower recurrence rate than use of the open technique.
The laparoscopic approach may be selected by a totally extraperitoneal (TEP) repair, a transabdominal preperitoneal repair (TAPP) and an intraperitoneal onlay mesh repair (IPOM).
The advantages of the IPOM approach over the others are that there is a large working space and familiar anatomic landmarks are visible. A problem is mesh separation due to inadequate fixation. The extracorporeal transfascial sutures at the corners of the mesh by separated skin incisions combined with spiral tracks fixations are recommended.