CURRENT OPTION IN

UMBILICAL HERNIA
REPAIR IN ADULTS PASIEN
By:
ILHAM CITRA HAMIDI
17710228
Abstract
• Umbilical hernia is a rather common surgical problem.
• Elective repair after diagnosis is advised
• Suture repairs have high recurrence rates; therefore, mesh
reinforcement is recommended
• Mesh can be placed through either an open or laparoscopic
approach with good clinical results
• Standard polypropylene mesh is suitable for the open onlay
technique; however, composite meshes are required for
laparoscopic repairs
• Obesity, ascites, and excessive weight gain following repair are
obviously potential risk factors. Moreover, smoking may create a
risk for recurrence.
Diagnosis
• Diagnosis of ACL tears can be based almost completely on the
history and physical examination.
• Unfortunately, pivot shift examination is difficult to perform in an
acutely injured knee and radiology is useful to make diagnosis
and determine the type of ACL injury.
Anamnesis
patient report ‘pop’ sound when jump which a combination of
hyperextension and rotating move on.
•patient then stop the exercise because pain, swelling and
instability
Physical examination
• In pediatric with acute traumatic hemarthrosis of genu,
radiology has be done first before the clinical exam to rule out a
tibial eminence fracture.
• a complete of knee examination is a very important tool in an
establishing the correct diagnosis.
• Lachmann and pivot shift test is an indicator of ACL injury.
Examination
• AP and lateral radiograph are given to rule out a tibial
eminence fracture.
• MR Imaging is very useful tool to in diagnosing ACL tear in acute
setting when the clinical exam is difficult.
Management
• The treatment of ACL tears in pediatric patients remains
changelling and controversial.
• Non operative treatment is offered to pediatric patient with
partial tears
Treatment algorithm for
ACL injury
Prevention of ACL injuries
• There are two recognized prevention programs, the FIFA-11 and
the PEP, which are designed to improve the athletes
neuromuscular control and prevent ACL injuries.
• This exercise also can prevent re-injury after ACL reconstruction
and graft have been heal.
Conclusion
1. Mesh repairs are superior to non-mesh/tissue-suture repairs in
umbilical hernia repairs
2. Open and laparoscopic techniques have almost similar
efficacy
3. Local anesthesia is suitable for small umbilical hernias and
patients with reasonable BMI
4. Antibiotic prophylaxis appears to provide low wound infection
rate.