1. ABDOMINAL WALL DEFECTS Celso M. Fidel, MD, FPCS,FPSGS Diplomate Philippine Board of Surgery

2. Introduction ABDOMINAL WALL  Complex musculo-aponeurotic structure  Attached to the :  Vertebral column posteriorly  Ribs superiorly  Bones of the pelvis inferiorly  Derived embryonically in a segmental, metameric manner, and is reflected in blood supply and innervation.

4. Introduction ABDOMINAL WALL It is the repository of the panniculus adiposus May reach considerable proportions in some members of the species afflicted with morbid obesity .

5. Introduction ABDOMINAL WALL Variety of pathology difficult to assess on physical examination. Computed tomography (CT) often delineates these abnormalities

6. GENERAL CONSIDERATIONS  VENTRAL HERNIA  UMBILICAL HERNIAS  EPIGASTRIC HERNIA  INCISIONAL HERNIA  TROCAR HERNIA  Emergency Abdominal wall Defects  Difficult Abdominal Wall Closure

7. ABDOMINAL WALL HERNIAS

8. UMBILICAL HERNIAS

9. UMBILICAL HERNIA

11. GENERAL CONSIDERATIONS  Other Abdominal Wall Hernia  Spigelian Hernia  Lumbar Hernia 1. Petit’s or inferior triangle hernia 2. Grynfelt’s or sup. Triangle hernia  Pelvic Floor Hernia 1. Obturator Hernia 2. Perineal Hernia 3. Sciatic Hernia

12. GENERAL CONSIDERATIONS  Other Abdominal Wall Hernia 4. Parastomal Hernia 5. Internal hernia (a) Normal Orifice (b) Abnormal Orifice (c) Iatrogenic ( post-operative)

13. GENERAL CONSIDERATIONS  Other Abdominal Wall Hernia 6. Co ngenital Abdominal Wall defect (a) Gastroschisis (b) Omphalocele 7. C ongenital Diaphragmatic Hernia (a) Bochdalek (b) Morgagni

18. Patient Rogelia Tacuban

20. Clear View of External O Aponeurosis

21. Separation of the Sac

22. CATTELL REPAIR

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