الفهرس 
Anattomy off tthee Antteerriiorr Abdomiinall WalllOnly 14 pages are availabe for public view
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Abstract
incisional hernia is a common long term complication following abdominal surgery as it is estimated to occur in approximately 10% of cases. However the true incidence is probably higher since the majority are asymptomatic. (Rudmik et al., 2006). The patient with incisional hernia commonly presents with unremarkable clinical symptoms, in the first instance. Most patients give a history of a lump or bulge that, elicited by physical activity such as exercise or coughing, and disappearing after stopping the activity. (Schumpelick ct al., 2006) Sonography is a helpful diagnosic aid, particularly in small or barely palpable hernias, or in obese patients, as it is non-invasive, time and cost-saving, readily repeatable, and practically risk-free. Besides location and size, ultrasonography allows the determination of hernial content, as well as excluding important differential diagnoses such as lymphoma or hematoma. (Schumpelick et al., 2006) The treatment of ventral incisional hernia is operative repair, and three general classes of operative repair have emerged in the modern era. These techniques include primary suture repair of the hernia, open repair of the hernia with prosthetic mesh, and laparoscopic incisional hernia repair. (Zinner and Ashley, 2007). Many variations of mesh repair for the incisional hernia have been described. (Zinner and Ashley, 2007).The onlay technique in which the mesh is placed over the abdominal wall closure in the subcutaneous prcfascial Mesh should be appropriately fixed either with sutures, staples, tackers or Endoanchors. If the mesh is not fixed, it may migrate and cause a recurrence. For intra-abdominal placement of the mesh, a few strong sutures should be placed at least at four corners of the mesh. Subsequently, mesh should be fixed with anchors at a distance of 3 cm all around to prevent any bowel obstruction by getting in between the mesh and the defect. (Doctor, 2006). Advantages of laparoscopy include precise identification of the location and type of hernia, excellent exposure, accurate placement of mesh, avoidance of major dissection or injury to surrounding structures (e.g., nerves, ureter), excellent cosmetic result and short postoperative convalescence. (Faddegon et al., 2008). Because the operation is performed through 3 or 4 trocars, the need for a long incision and extensive fascial or skin flap dissection is eliminated. Therefore, when the laparoscopic technique is used, one of the most morbid aspects of ventral herniorrhaphy potentially is eliminated. (Perrone et al., 2005). The laparoscopic approach appears to be effective in complex patients, such as the obese and those who have failed prior open repairs. Obese patients especially may benefit because of the smaller wounds and, theoretically, decreased wound complications. (Perrone et al., 2005).
Another possible advantage of laparoscopic repair regards obese patients. Operative time is shorter than in open surgery, as is postoperative hospitalization. Morbid obesity is not a contraindication to laparoscopic repair
(Kingsnorth, 2006). (Kingsnorth, 2006).(Kingsnorth, 2006).(Kingsnorth, 2006).(Kingsnorth, 2006).(Kingsnorth, 2006).(Kingsnorth, 2006). (Kingsnorth, 2006). (Kingsnorth, 2006).(Kingsnorth, 2006).(Kingsnorth, 2006).(Kingsnorth, 2006).(The inlay technique in which the fascial edges are not approximated and the mesh lies in contact with the underlying viscera. (Kingsnorth, 2006). The underlay technique can place the mesh within the peritoneal cavity, intraperitoneal, or extraperitoneal, which was first described by Stoppa in 1989. Both variations have the advantage of minimal soft-tissue dissection thus reducing devascularized tissue. (Rudmik et al., 2006). Generally, the task of a surgical mesh implant is to provide biomechanical strength to the attenuated fascial structures. Surgical mesh is designed to withstand the tension forces acting on the abdominal wall. Further, the mesh must not impede and ideally should facilitate the healing process of the hernial defect by encouraging ingrowth of the body’s own connective tissue by the induction of strong collagen tissue around the mesh fibers. (Doctor, 2006).
Mesh should be appropriately fixed either with sutures ,stples , tackers or endoanchors. If the mesh is not fixed . it may migrate and cause a recurrence . Subsequenty , mesh should be fixed with anchors at a distance of 3 cm all around to prevent any bowel obstruction by getting in between the mesh and the defect. (Doctor, 2006).
Advantage of laparoscopy include precise identification of the location and type of hernia , excellent exposure , accurate placement of mesh , avoidance of major dissection or injury to surroundings and short postoperative convalescence (Faddegon et al .,2008)
Because the operation is performed through 3 or 4 trocars , the need for a long incision and extensive fascial or skin flap dissection is eliminated . Therefore , when the laparoscopic technique is used , one of the most morbid aspects of ventral herniorrhaphy potentially is eliminated. (Perrone et al.,2005)Laparoscopic incisional hernia repair is a better procedure than the anterior approach. It is associated with a shorter operative time and hospitalization , a faster ability to return to the work and lower rate of complication . (Olmi et al.,2006) (Olmi et al.,2006)(Olmi et al.,2006)(Olmi et al.,2006) (Olmi et al.,2006)(Olmi et al.,2006)(Olmi et al.,2006) (Olmi et al.,2006)(Olmi et al.,2006)(Olmi et al.,2006)(Olmi et al.,2006)(