hernias de la paredabdominal

7/23/2019 hernias de la paredabdominal

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HERNIAS DE LA PARED ABDOMINALIsabel Rojas Marquez

UNIVERSIDAD AUTNOMA DE CHIHUAHUA

FACULTAD DE MEDICINA

CIRUGA


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OBJETIOS

Co!o"er los "o#$o!e!%es &e u!a 'er!(a)as* "o#o su "las(+"a"(,!-

I&e!%(+"ar los $r(!"($ales s(%(os &e

'er!(a"(,!-Co!o"er la s(!%o#a%olo.*a / la a!a%o#*a

&e u!a 'er!(a) &e$e!&(e!&o &e suub("a"(,!-

O$"(o!es %era$0u%("as) / las"o#$l("a"(o!es &e &("'os %ra%a#(e!%os-


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DE1INICIONES

U!a 'er!(aes la $ro%rus(,! &e u!a2*s"era a %ra20s &e u!a aber%ura e!la $are& &e la "a2(&a& que la"o!%(e!e-

Or(+"(oSa"o

'er!(ar(

os

Hernia


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DE1INICIONES


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HERNIAS3 DE1INICIONES

El "uello &el sa"o 'er!(ar(o"orres$o!&e al or(+"(o -

S( el sa"o sale$or "o#$le%o a%ra20s &e la$are&

ab&o#(!al-

Externa

S( se e!"ue!%ra&e!%ro &e la"a2(&a& 2(s"eral-

Interna


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Reducible

Cua!&o es $os(ble re.resar alab&o#e! la 2*s"era que 'a

sal(&o- Es$o!%4!eas o#a!uales-

Irreducible

Cua!&o !o es $os(blere.resar al ab&o#e! la2*s"era que 'a sal(&o-

Cr,!("as / a.u&as-

Estrangulada

Se "o#$ro#e%e la2as"ular(&a& &e la 2*s"era

que 'a sal(&o

Incarcerada Es u!a (rre&u"(ble) $ero !o!e"esar(a#e!%e es%ra!.ula&a

DeRichter

Es aquella e! que el sa"o s,lo"o!%(e!e u! la&o &e la $are& &el

(!%es%(!o 5s(e#$re

a!%(#ese!%0r("o6

HERNIAS3 DE1INICIONES


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SITIOS DE HERNIACI7N

I!.le O#bl(.o L*!eas bla!"a / se#(lu!ar &e S$(e.'el

D(a8ra.#a I!"(s(o!es qu(r9r.("as O%ras zo!as &e 'er!(a"(,! #4s raras so!3

Per(!eo) %r(4!.ulos lu#bares su$er(or &eGr/!8el% e (!8er(or &e Pe%(% / a.ujerosob%ura&or / "(4%("o &e la $el2(s-


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SINTOMAS : DIAGN7STICO

Al.u!os $a"(e!%es "o! 'er!(as !ose &a! "ue!%a &e su $rese!"(a'as%a que se les (!&("a-

Las s(!%o#4%("as $ro&u"e! u!a.ra! 2ar(e&a& &e #oles%(as(!es$e"*+"as rela"(o!a&as "o! el

"o!%e!(&o &el sa"o / la $res(,! queel #(s#o ejer"e e! el %ej(&o 2e"(!o-


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Las #oles%(as so! #a/ores al +!al &el&*a / se al(2(a! $or la !o"'e-

El &olor &e la (!.le s(! 'er!(a

&e#os%rable !o suele (!&("ar o a!u!"(arel (!("(o &e u!a 'er!(a-

Las (!.u(!ales !o "ausa! &olor %es%("ular- Cas( %o&as se &esarrolla! &e #a!era

(!s(&(osa-


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Se &(a.!os%("a! "o! 8a"(l(&a& e! el e;a#e!8*s("o

El sa"o &e u!a 'er!(a "o! su"o!%e!(&o "re"e / %ra!s#(%e u!(#$ulso $al$able "ua!&o el $a"(e!%e$uja o %ose-

Es%ar &e $(e &ura!%e el e;a#e!- Los '(&ro"eles se %ra!s(lu#(!a!) las

'er!(as !o-

Ul%raso!(&o o TC-



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E


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La'er!(aes%4%e!sa)#u/se!s(ble/la$(elquelare"ubre$ue&e%e!eru!%(!%eroj(zooazula&o-

Pro&u"e&olor(!%e!soe!la'er!(a-

H($erse!s(b(l(&a&

Obs%ru""(,!(!%es%(!alS(.!osos*!%o#as&ese$s(s-Co!%ra(!&("a&ore&u"(ru!a'er!(a

es%ra!.ula&as('a/se$s(s-U!a2ezqueselle2aa"abola

rea!(#a"(,!es%4(!&("a&au!ao$era"(,!&eur.e!"(a-

Herniaestrangul

ada



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INDICACIONES PARA CIRUGA

o E! .e!eral) &ebe! re$ararse %o&aslas 'er!(as-

o Her!(a "o! "uello a!"'o / u! sa"osu$er+"(al que se a!%("($a "re"er4"o! le!%(%u&-

o Calzo!"(llos / "(!%uro!esqu(r9r.("os 5bra.ueros6-


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HERNIAS DE LA INGLEEPIDEMIOLOGA

=>? &e %o&as las 'er!(as3 (!.le Her!(as (!&(re"%as sobre$asa! e!

!u#ero a las &(re"%as e! "as( @3- So! #4s "o#u!es las 'er!(as

(!.u(!ales &el la&o &ere"'o- Rela"(,! 2ar,!#ujer &e las

'er!(as (!.u(!ales es &e =3-

HERNIAS DE LA INGLE


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Pl(e.ue (!.u(!al (!.u(!ales o8e#orales-

Pue&e! ser &(re"%as o (!&(re"%as- Las 'er!(as 8e#orales (!%e.ra! #e!os

&el ? &el %o%al &e las 'er!(as(!.u(!ales-

La 8re"ue!"(a &e las 8e#orales es "ua%ro2e"es #a/or e! las #ujeres que e! los'o#bres-

HERNIAS DE LA INGLEEPIDEMIOLOGA


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I!&(re"%

aEl sa"o $asa a %ra20s&el a!(llo (!.u(!al

$ro8u!&o) a8uera &e

los 2asos e$(.4s%r("os(!8er(ores / $or 9l%(#oal es"ro%o-

D(re"%a

El sa"o sale&(re"%a#e!%e a %ra20s&el $(so &el "o!&u"%o

(!.u(!al) $or &e!%ro &e

los 2asos e$(.4s%r("os(!8er(ores / rara 2es&es"(e!&e al es"ro%o-

HERNIAS DE LA INGLE

HERNIA INGUINAL


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HERNIA INGUINAL3DIRECTA E INDIRECTA


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HERNIAS 1EMORALES 5CRURALES6

Se $rese!%a! "o#o u!a #asa (rre&u"(blee! el 4rea &el %r(4!.ulo 8e#oral-

Au!que el sa"o $ue&a es%ar 2a"*o) es

(rre&u"(ble $or .rasa / .a!.l(os l(!84%("os&el "o!&u"%o "rural que la ro&ea!- U! .a!.l(o l(!84%("o "re"(&o sol(%ar(o $ue&e

s(#ular "o! e;a"%(%u& u!a 'er!(a "rural- So! $ar%("ular#e!%e $el(.rosas $or las

es%ru"%uras r*.(&as que "o!s%(%u/e! ela!(llo 8e#oral-


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HERNIAS 1EMORALES 5CRURALES6


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HERNIA INGUINAL PORDESLIAMIENTO

Alu&e a "ualqu(er 'er!(a e! la que $ar%e&el sa"o es la $are& &e u!a 2*s"era-

Corres$o!&e al F? &e las 'er!(as

(!.u(!ales) $ero la (!"(&e!"(a serela"(o!a "o! la e&a&-

Rara 2ez se e!"ue!%ra e! (!&(2(&uos#e!ores &e aos) au!que au#e!%aa @? &es$u0s &e los = aos-


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S( la 'er!(a se 'alla a la &ere"'a)$ar%("($a! #4s a #e!u&o3 "(e.o)"olo! as"e!&e!%e o a$0!&("e-

La&o (zqu(er&o3 "olo! s(.#o(&e- E! a#bos la&os $ue&e! (!%er2e!(r

9%ero) %ro#$as &e 1alo$(o) o2ar(os)ur0%eres / 2ej(.a-

HERNIA INGUINAL PORDESLIAMIENTO


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ANATOMA DE LA HERNIA INGUINAL

El sa"o &e u!a 'er!(a (!&(re"%a es la&(la%a"(,! &e u! $ro"eso 2a.(!al$ers(s%e!%e-

El sa"o (!&(re"%o se a"o#$aa &e .rasa$re$er(%o!eal / se "o!o"e "o#o l($o#a&e "or&,!-

Los ,r.a!os re%ro$er(%o!eales $ue&e!&esl(zarse al (!%er(or &e u! sa"o(!&(re"%o-

ANATOM A DE LA HERNIA INGUINAL


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Los sa"os &e u!a 'er!(a (!.u(!al&(re"%a !o es%4! "o!%e!(&os $or laa$o!euros(s &el #9s"ulo obl("uo

#a/or 5e;%er!o6- Rara 2ez "re"e! %a!%o "o#o $ara

8orzarse / se.u(r a %ra20s &el a!(llo

su$er+"(al / &es"e!&er al es"ro%o-




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Los sa"os &e u!a 'er!(a 8e#oral seor(.(!a! e! el "o!&u"%o "rural a%ra20s &e u! &e8e"%o e! el la&o

(!%er!o &e la 2a(!a 8e#oral- Los .a!.l(os se e;$ulsa! &el

"o!&u"%o "rural $or u!a $ro%rus(,!

$er(%o!eal / "o! 8re"ue!"(a or(.(!a!u!a #asa $al$able-




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ARONES

Paso &el%es%*"ulo a

%ra20s &e la$are& &el

ab&o#e!

Deb(l(%a /au#e!%a el

or(+"o

#(o$e"%*!eo

Pre&(s$os("(,!a 'er!(as

(!.u(!ales

D(re"%as e

(!&(re"%as Mujeres so! #4s$re&(s$o!e!%es a&esarrollar 'er!(a

"rural



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CAUSA

Las 'er!(as (!.u(!ales $ue&e! ser"o!.0!(%as o a&qu(r(&as-

I!&(re"%as Co!.0!(%as Pro"eso 2a.(!al

F? RN

>? N(os &e ao @? A&ul%os

CAUSA


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Debe! e;(s%(r o%ros 8a"%ores queor(.(!e! u!a (!su+"(e!"(a &e la8as"(a %ra!s2ersal $ara re%e!er el

sa"o 2(s"eral e! el or(+"(o#(o$e"%*!eo3Pos%ura ere"%a &el 'o#bre

De+"(e!"(a #us"ularDes%ru""(,! &el %ej(&o "o!ju!%(2o

CAUSA


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BASES DE LA REPARACI7N DE UNAHERNIA INGUINAL

Hernioplastia inguinal: $re2e!(r lasal(&a &el $er(%o!eo a %ra20s &el&e8e"%o &e la $are& &el ab&o#e!-a) Cierre aponurotico &el &e8e"%o &e la

'er!(a e! la e;%e!s(,! !e"esar(a-b) Restitucin de la fascia transversal

defectuosa "o! u!a $r,%es(s s(!%0%("a.ra!&e-

BASES DE LA REPARACI7N DE UNA


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Se $ue&e! re$arar $or la $ar%e a!%er(or o$os%er(or 5hernioplastias preperitoneales6-

La %e!s(,!es la "ausa $r(!"($al &e

8ra"aso &e las 'er!(o$las%(as que "(erra!el or(+"(o #(o$e"%*!eo #e&(a!%ea$ro;(#a"(,! a$o!eur,%("a-

Las re$ara"(o!es "o! $r,%es(s3 $a"(e!%es

"o! r(e.o al%o &e re"urre!"(a &es$u0s &eu!a 'er!(o$las%(a "l4s("a-

BASES DE LA REPARACI7N DE UNAHERNIA INGUINAL


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HERNIOPLASTIA SIN TENSION

Cua!&o se (#$la!%a las $r,%es(s s(!u!a re$ara"(,! 8or#al) #ejora! losresul%a&os &e #a!era es$e"%a"ular Es%a %e"!("a 8ue &e8e!&(&a $or

L("'%e!s%e(! No se re"o#(e!&a $ara 'er!(as

re"urre!%es) $orque es $os(ble queel $ar"'e !o (#$(&a la $ro%rus(,! a%ra20s &el &e8e"%o +broso

sub/a"e!%e


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Her!(as re"urre!%es

.ra!&es / "o! #9l%($les&e8e"%os a$o!eur,%("os

Se re$ara! #ejor "o! el#0%o&o $re$er(%o!eal $os%er(or$er#a!e!%e "o! $r,%es(s


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HERNIOPLASTIA INGUINALPREPERITONEAL

El es$a"(o$re$er(%o!eal es u!

s(%(o al%er!a%(2o $ara(#$la!%ar u!a

$r,%es(s

El(#(!ar 'er!(as &e la(!.le "o! $r,%es(s !o

resorb(ble queree#$laza la 8as"(a

%ra!s2ersal

La $r,%es(s sea&'(ere al sa"o

2(s"eral e (#$(&eque el $er(%o!eo se

e;%(e!&a

RSPG3 re8uerzo &elsa"o 2(s"eral "o!

$r,%es(s .(.a!%e- O

$ro"e&(#(e!%o &eS%o$$a

Cua!&o se 'a"e"orre"%a#e!%e "ura

%o&as las 'er!(as(!.u(!ales-

Re"u$era"(,! r4$(&a/ #oles%(a #*!(#a


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REPARACI7N LAPAROSC7PICA

Se (#$la!%a u!a $r,%es(s &e #allas(!%0%("a 2*a %ra!s$er(%o!eal oe;%ra$er(%o!eal

Los sa"os &e 'er!(as (!.u(!ales(!&(re"%as se "or%a! e! el "uello /se &eja el sa"o &(s%al (! s(%u- Se (#$la!%a la #alla $ara "ubr(r

el or(+"(o &e la 'er!(a


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COMPLICACIONES

Las &os "o#$l("a"(o!es) au!queraras so!3 Orqu(%(s (squ0#("a3 "o! su a%ro+a

%es%("ular Neural.(a re.(o!al

So! #as 8re"ue!%es &es$u0s &eu!a 'er!(o$las%(a (!.u(!al a!%er(or

Las re"urre!"(as so! u!a"o#$l("a"(,!


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E! re$ara"(o!es "l4s("as la 8re"ue!"(a&e re"urre!"(as es e!%re / ?

Se &ebe a3 Te!s(,! e;"es(2a e! la re$ara"(,! Tej(&os &e+"(e!%es Her!(o$las%(a (!a&e"ua&a Her!(as que se $asa! $or al%o

So! #as "o#u!es e! $a"(e!%es "o!

'er!(as &(re"%as


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HERNIA UMBILICAL

So! #as 8re"ue!%es e! #ujeres- Los$re"ursores "o#u!es so! obes(&a& /e#barazos re$e%(&os

Es "o#9! que se es%ra!.ule! "olo! / e$($l,! So! "o#u!es e! la"%a!%es / "(erra! &e #a!era

es$o!%a!ea s(! T; s( el &e8e"%o a$o!eur,%("oes #e!or &e ->"# I!&("a&a re$ara"(,! e! &e8e"%os #a/ores &e

@- "#- O "ua!&o $ers(s%e a los o aos


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La re$ara"(,! "l4s("a es la'er!(o$las%(a &e #a/o Co!s(s%e e! (#br("ar) a

#a!era &e "'ale"o sobre

los $a!%alo!es) losse.#e!%os a$o!eur,%("ossu$er(or e (!8er(or

Las 'er!(as u#b(l("ales.ra!&es se %ra%a! &e$re8ere!"(a "o! u!a$r,%es(s


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HERNIA EPIGSTRICA

Es u!a sal(e!%e &e la .rasa$re$er(%o!eal / el $er(%o!eo a %ra20s&e las +bras &e la 2a(!a &el re"%o

que se &e"usa! e! la l*!ea #e&(ae!%re la a$,+s(s ;(8o(&es / el o#bl(.o Co! 8re"ue!"(a !o se re&u"e!

Es 84"(l re$ararlas a %ra20s &e u!a(!"(s(,! 2er%("al e! la $(el


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HERNIA DE SPIEGHEL

Her!(as 2e!%rales que o"urre! a lolar.o &e la $or"(,! subu#b(l("al &ela l*!ea se#(lu!ar &e S$(e.'el

So! raras / &(8*"(les &e&(a.!os%("ar $orque es%4!"o!%e!(&as $or la a$o!euros(s &el

#us"ulo obl("uo #a/or Las .ra!&es $ue&e! "o!8u!&(rse

"o! sar"o#as &e la $(el &el

ab&o#e!


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La 8as"(a &e S$(e.'el "o!s(s%ee! las a$o!euros(s 8us(o!a&as&e los #9s"ulos obl("uo #e!or/ %ra!s2erso &el ab&o#e!)e!%re el 2(e!%re &e es%os

#9s"ulos 'a"(a a8uera / el#us"ulo re"%o e! la l*!ea#e&(a

La 'er!(a $equea se "(erras(#$le#e!%e) $ero las .ra!&es

que se e!"ue!%ra! e! los#9s"ulos requ(ere! $r,%es(s


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HERNIAS INCISIONALES

Proble#a qu(r9r.("o (#$or%a!%e Sus "ausas $r(!"($ales so! obes(&a& e

(!8e""(,!

Causa u! #o2(#(e!%o ab&o#(!al res$(ra%or(o$ara&,j("o- Es ese!"(al 2alorar la 8u!"(,!res$(ra%or(a

La re&u""(,! &e las 2*s"eras &ura!%e la

o$era"(,! $ue&e "ausar la #uer%e $or"o#$res(,! &e la 2e!a "a2a (!8er(or e(!su+"(e!"(a res$(ra%or(a


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El !eu#o$er(%o!eo es u!a %e"!("a 9%(le! al $re$ara"(,! &el $a"(e!%e $ara'er!(o$las%(a (!s("(o!al

Cas( %o&as las 'er!(as $equeas se%ra%a! "o! u! "(erre s(#$le- Las #a/ores &e "#- T(e!e!

re"urre!"(a &el >? Se requ(ere u!a $r,%es(s


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Her!(o$las%(a &e S%o$$a Co!s(s%e e! u!a $r,%es(s &e

Mers(le!e que se (#$la!%a e! la$ro8u!&(&a& &e los #9s"ulos) e!la $ar%e su$er(or &e la 2a(!a$os%er(or &el re"%o o el $er(%o!eo

/ se e;%(e!&e #u"'o #as all4 &elos bor&es &e los &e8e"%os#(oa$o!euro%("os


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IN1ECCI7N

Es u!a "o#$l("a"(,! (#$or%a!%e Las %e#$ra!as se %ra%a! #e&(a!%e la

e;$os("(,! r4$(&a / %o%al &e la $r,%es(s

Tra%a#(e!%o a!%(b(,%("o s(s%0#("o /lo"al

Cua!&o o"urre! (!8e""(o!es %ar&*as !osuele re(!%e.rarse la $r,%es(s a8e"%a&a /es !e"esar(o e;%(r$ar su $or"(,!se"ues%ra&a


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RESUMEN

Los "o#$o!e!%es $r(!"($ales &e u!a 'er!(a so! elor(+"(o / el sa"o 'er!(ar(o-

U!a 'er!(a $ue&e ser (!%er!a o e;%er!a) re&u"(bleo (rre&u"(ble) (!"ar"era&a o es%ra!.ula&a-

El s(%(o #4s "o#9! &e 'er!(a"(,! es e! la (!.le-U!a 'er!(a (!.u(!al $ue&e ser &(re"%a o (!&(re"%a-Su e%(olo.*a es #ul%(8a"%or(al-To&a 'er!(a &ebe ser re$ara&a $ara e2(%ar

"o#$l("a"(o!es $os%er(ores-

RESUMEN


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Los resul%a&os &e u!a 'er!(o$las%(a s(! %e!s(,!so! e2(&e!%e#e!%e #as 8a2orables-

Las 'er!(as .ra!&es / re"urre!%es se re$ara!#ejor "o! $r,%es(s-

Las "o#$l("a"(o!es &e la 'er!(o$las%(a (!.u(!also! la orqu(%(s (squ0#("a / la !eural.(a re.(o!al-

La 'er!(a u#b(l("al es "o#9! e! la"%a!%es /"(erra es$o!%4!ea#e!%e s( es #e!or &e -> "#-La obes(&a& / las (!8e""(o!es so! las "ausas &e

la 'er!(a (!"(s(o!al-

La (!8e""(,! es u!a "o#$l("a"(,! "o#9! &e"ualqu(er 'er!(o$las%(a / $ue&e ser %e#$ra!a o%ar&*a-

RESUMEN


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CONCLUSIONES

Es (#$or%a!%e "o!o"er los &(8ere!%es %($os&e 'er!(as $ara $o&er or(e!%ar !ues%ros&(a.!,s%("os

Es (#$or%a!%e "o!o"er los r(es.os que%(e!e "a&a %($o &e 'er!(a / su "o#$l("a"(,!$ara $e!sarlos a la 'ora &e u! &(a.!os%("o

Es (#$or%a!%e "o!o"er los &(8ere!%es

%ra%a#(e!%os &e las 'er!(as $ara or(e!%ar alos $a"(e!%es


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GRACIASKKK


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BIBLIOGRA1A

S"'ar%z) S'(res / S$e!"er- PRINCIPIOS DECIRUGA- E&("(,!- E&(%or(al(!%era#er("a!a M"GraH(ll $a.(!as @=@

S"'ar%z) S'(res / S$e!"er- PRINCIPIOS DECIRUGA- F E&("(,!- E&(%or(al(!%era#er("a!a M"GraH(ll $a.(!as @F>

hernias de la paredabdominal

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