const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Medical Education";
pres.title = "Hernia – A Comprehensive Seminar";

// ── COLOUR PALETTE ──────────────────────────────────────────────────────────
const NAVY   = "0D2B55";   // dominant dark blue
const TEAL   = "0A7C8C";   // accent
const GOLD   = "E8A020";   // highlight
const WHITE  = "FFFFFF";
const LIGHT  = "EAF4F6";   // very pale teal background
const SLATE  = "2C3E50";   // dark text
const LGRAY  = "BDC3C7";   // subtle divider

// ── HELPERS ──────────────────────────────────────────────────────────────────
function sectionDivider(title) {
  const sl = pres.addSlide();
  sl.background = { color: NAVY };
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 2.2, w: 10, h: 1.25, fill: { color: TEAL }, line: { type: "none" } });
  sl.addText(title, { x: 0.5, y: 2.3, w: 9, h: 1.05, fontSize: 38, bold: true, color: WHITE, align: "center", valign: "middle", fontFace: "Calibri" });
  sl.addShape(pres.ShapeType.rect, { x: 1.5, y: 3.6, w: 7, h: 0.06, fill: { color: GOLD }, line: { type: "none" } });
}

function titleSlide() {
  const sl = pres.addSlide();
  sl.background = { color: NAVY };
  // top accent bar
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.18, fill: { color: TEAL }, line: { type: "none" } });
  // gold vertical bar
  sl.addShape(pres.ShapeType.rect, { x: 0.5, y: 0.8, w: 0.18, h: 4, fill: { color: GOLD }, line: { type: "none" } });
  sl.addText("HERNIA", { x: 0.9, y: 0.9, w: 9, h: 1.4, fontSize: 72, bold: true, color: WHITE, fontFace: "Calibri", charSpacing: 8 });
  sl.addText("A Comprehensive Seminar for Medical Students", { x: 0.9, y: 2.3, w: 9, h: 0.7, fontSize: 22, color: LGRAY, fontFace: "Calibri", italic: true });
  sl.addShape(pres.ShapeType.rect, { x: 0.9, y: 3.1, w: 6, h: 0.06, fill: { color: TEAL }, line: { type: "none" } });
  sl.addText("Bailey & Love's Surgery | Schwartz's Principles | Greenfield's Surgery", {
    x: 0.9, y: 3.3, w: 9, h: 0.4, fontSize: 13, color: LGRAY, italic: true, fontFace: "Calibri"
  });
  // bottom bar
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.42, w: 10, h: 0.2, fill: { color: GOLD }, line: { type: "none" } });
}

function contentSlide(title, bullets, opts = {}) {
  const sl = pres.addSlide();
  sl.background = { color: opts.bg || WHITE };
  // header bar
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.0, fill: { color: NAVY }, line: { type: "none" } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0.9, w: 10, h: 0.1, fill: { color: TEAL }, line: { type: "none" } });
  sl.addText(title, { x: 0.4, y: 0.05, w: 9.2, h: 0.85, fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", valign: "middle", margin: 0 });

  const items = bullets.map((b, i) => {
    if (typeof b === "string") {
      return { text: b, options: { bullet: { type: "bullet" }, fontSize: opts.fs || 18, color: SLATE, fontFace: "Calibri", breakLine: i < bullets.length - 1 } };
    }
    // { text, sub } for sub-bullets
    return [
      { text: b.text, options: { bullet: { type: "bullet" }, fontSize: opts.fs || 18, bold: true, color: SLATE, fontFace: "Calibri", breakLine: true } },
      ...b.subs.map((s, si) => ({ text: "     " + s, options: { bullet: false, fontSize: (opts.fs || 18) - 2, color: TEAL, fontFace: "Calibri", breakLine: si < b.subs.length - 1 || i < bullets.length - 1 } }))
    ];
  }).flat();

  sl.addText(items, { x: 0.5, y: 1.15, w: 9, h: 4.2, valign: "top" });
  // footer gold line
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.42, w: 10, h: 0.07, fill: { color: GOLD }, line: { type: "none" } });
  sl.addText("Hernia Seminar  |  Medical Students", { x: 0.3, y: 5.48, w: 9, h: 0.14, fontSize: 9, color: LGRAY, fontFace: "Calibri" });
  return sl;
}

function twoColSlide(title, leftBullets, rightBullets, leftHead = "", rightHead = "") {
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.0, fill: { color: NAVY }, line: { type: "none" } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0.9, w: 10, h: 0.1, fill: { color: TEAL }, line: { type: "none" } });
  sl.addText(title, { x: 0.4, y: 0.05, w: 9.2, h: 0.85, fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", valign: "middle", margin: 0 });

  // divider
  sl.addShape(pres.ShapeType.rect, { x: 4.95, y: 1.1, w: 0.07, h: 4.2, fill: { color: LGRAY }, line: { type: "none" } });

  if (leftHead) sl.addText(leftHead, { x: 0.3, y: 1.1, w: 4.5, h: 0.4, fontSize: 15, bold: true, color: TEAL, fontFace: "Calibri" });
  if (rightHead) sl.addText(rightHead, { x: 5.1, y: 1.1, w: 4.5, h: 0.4, fontSize: 15, bold: true, color: TEAL, fontFace: "Calibri" });

  const mkItems = (arr) => arr.map((b, i) => ({ text: b, options: { bullet: { type: "bullet" }, fontSize: 16, color: SLATE, fontFace: "Calibri", breakLine: i < arr.length - 1 } }));
  sl.addText(mkItems(leftBullets),  { x: 0.3, y: leftHead ? 1.55 : 1.15, w: 4.5, h: 3.7, valign: "top" });
  sl.addText(mkItems(rightBullets), { x: 5.1, y: rightHead ? 1.55 : 1.15, w: 4.7, h: 3.7, valign: "top" });

  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.42, w: 10, h: 0.07, fill: { color: GOLD }, line: { type: "none" } });
  sl.addText("Hernia Seminar  |  Medical Students", { x: 0.3, y: 5.48, w: 9, h: 0.14, fontSize: 9, color: LGRAY, fontFace: "Calibri" });
  return sl;
}

function tableSlide(title, headers, rows) {
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.0, fill: { color: NAVY }, line: { type: "none" } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 0.9, w: 10, h: 0.1, fill: { color: TEAL }, line: { type: "none" } });
  sl.addText(title, { x: 0.4, y: 0.05, w: 9.2, h: 0.85, fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", valign: "middle", margin: 0 });

  const tableData = [
    headers.map(h => ({ text: h, options: { bold: true, color: WHITE, fill: TEAL, fontSize: 14, fontFace: "Calibri", align: "center" } })),
    ...rows.map((row, ri) => row.map(cell => ({ text: cell, options: { color: SLATE, fill: ri % 2 === 0 ? LIGHT : WHITE, fontSize: 13, fontFace: "Calibri" } })))
  ];
  sl.addTable(tableData, { x: 0.3, y: 1.1, w: 9.4, colW: headers.map(() => 9.4 / headers.length), border: { pt: 1, color: LGRAY } });
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.42, w: 10, h: 0.07, fill: { color: GOLD }, line: { type: "none" } });
  sl.addText("Hernia Seminar  |  Medical Students", { x: 0.3, y: 5.48, w: 9, h: 0.14, fontSize: 9, color: LGRAY, fontFace: "Calibri" });
  return sl;
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDES
// ═══════════════════════════════════════════════════════════════════════════

// 1. TITLE
titleSlide();

// 2. OUTLINE
contentSlide("Seminar Outline", [
  "1.  Definition & Historical Background",
  "2.  Surgical Anatomy of the Groin",
  "3.  Aetiology & Pathophysiology",
  "4.  Classification of Hernias",
  "5.  Inguinal Hernia – Direct vs Indirect",
  "6.  Femoral Hernia",
  "7.  Other Abdominal Wall Hernias",
  "8.  Special / Rare Hernias",
  "9.  Clinical Features & Diagnosis",
  "10. Complications: Incarceration & Strangulation",
  "11. Investigations",
  "12. Surgical Repair – Open Techniques",
  "13. Surgical Repair – Laparoscopic Techniques",
  "14. Complications of Repair",
  "15. Special Situations & Paediatric Hernias",
  "16. Key Points & Summary",
], { fs: 16 });

// ── SECTION 1: DEFINITION ────────────────────────────────────────────────────
sectionDivider("01  Definition & Background");

contentSlide("What Is a Hernia?", [
  "A hernia is the protrusion of a viscus (or part of a viscus) through a normal or abnormal opening in the wall of its containing cavity",
  "Three essential components:",
  "     ▸ The SAC – a diverticulum of peritoneum",
  "     ▸ The CONTENTS – omentum, bowel, bladder, ovary, etc.",
  "     ▸ The COVERINGS – layers of abdominal wall overlying the sac",
  "The word derives from the Latin 'hernos' = rupture",
  "Hernia repair is one of the most commonly performed operations worldwide – ~20 million/year globally",
]);

contentSlide("Historical Milestones", [
  "1887 – Eduardo Bassini described the first anatomical repair (Bassini repair)",
  "1898 – Halsted modified the repair with transposition of spermatic cord",
  "1945 – Shouldice introduced the four-layer tissue repair",
  "1980s – Lichtenstein described tension-free flat mesh repair (still most common open repair today)",
  "1990s – Laparoscopic TEP and TAPP techniques developed",
  "2018 – European Hernia Society (EHS) International Guidelines published",
]);

// ── SECTION 2: ANATOMY ──────────────────────────────────────────────────────
sectionDivider("02  Surgical Anatomy of the Groin");

contentSlide("Layers of the Abdominal Wall (Outside → In)", [
  "1. Skin",
  "2. Camper's fascia (superficial fatty layer)",
  "3. Scarpa's fascia (deeper membranous layer)",
  "4. External oblique muscle / aponeurosis",
  "5. Internal oblique muscle",
  "6. Transversus abdominis muscle",
  "7. Transversalis fascia",
  "8. Extraperitoneal fat",
  "9. Peritoneum",
  "Clinical pearl: The conjoint tendon = fused aponeuroses of internal oblique + transversus abdominis",
]);

contentSlide("The Inguinal Canal", [
  "Oblique tunnel ~4 cm long, running superomedially above the inguinal ligament",
  "Anterior wall: external oblique aponeurosis (whole length) + internal oblique (lateral 1/3)",
  "Posterior wall: transversalis fascia (whole length) + conjoint tendon (medial 1/3)",
  "Roof: arching fibres of internal oblique and transversus abdominis",
  "Floor: inguinal ligament + lacunar ligament medially",
  "Deep (internal) inguinal ring: defect in transversalis fascia – lateral to inferior epigastric vessels",
  "Superficial (external) inguinal ring: defect in external oblique aponeurosis",
  "Contents ♂: spermatic cord (vas deferens, testicular artery, pampiniform plexus, ilioinguinal nerve)",
  "Contents ♀: round ligament of uterus + ilioinguinal nerve",
]);

contentSlide("Hesselbach's Triangle (Direct Hernia Space)", [
  "Defined by three boundaries:",
  "     ▸ Medial border: lateral edge of rectus abdominis",
  "     ▸ Inferior border: inguinal ligament",
  "     ▸ Lateral border: inferior epigastric vessels",
  "Floor of triangle = transversalis fascia (weakest point → direct hernia)",
  "Direct hernias bulge through Hesselbach's triangle – MEDIAL to inferior epigastric vessels",
  "Indirect hernias pass through the deep ring – LATERAL to inferior epigastric vessels",
  "Memory aid: 'MDs DIRECT patients' – Medial Direct",
]);

contentSlide("The Femoral Canal", [
  "Located in the femoral sheath, most medial compartment",
  "Boundaries of femoral ring:",
  "     ▸ Anterior: inguinal ligament",
  "     ▸ Posterior: pectineal ligament (Cooper's ligament)",
  "     ▸ Medial: lacunar ligament",
  "     ▸ Lateral: femoral vein",
  "Femoral canal normally contains fat and Cloquet's lymph node",
  "BELOW the inguinal ligament → distinguishes femoral from inguinal hernia",
  "Narrow rigid neck → high risk of strangulation (~40% present as emergencies)",
]);

// ── SECTION 3: AETIOLOGY ────────────────────────────────────────────────────
sectionDivider("03  Aetiology & Pathophysiology");

contentSlide("Aetiology – Risk Factors", [
  { text: "Congenital factors", subs: ["Patent processus vaginalis (indirect inguinal hernia)", "Weak transversalis fascia", "Prematurity, low birth weight (inguinal hernia in infants)"] },
  { text: "Raised intra-abdominal pressure", subs: ["Chronic cough, constipation, urinary outflow obstruction (BPH)", "Heavy lifting, pregnancy, ascites, obesity"] },
  { text: "Weakened abdominal wall", subs: ["Ageing, malnutrition, collagen disorders (Marfan, Ehlers-Danlos)", "Previous surgery → incisional hernia", "Smoking (impairs collagen synthesis)"] },
  { text: "Other", subs: ["Male sex (M:F 10:1 for inguinal), multiparity (umbilical)"] },
]);

contentSlide("Epidemiology – Key Numbers", [
  "Inguinal hernias = 75% of all abdominal wall hernias",
  "Femoral = 5%  |  Incisional + umbilical + epigastric = 15%  |  Others = 5%",
  "Lifetime risk: ~25% in males, ~5% in females",
  "Indirect inguinal : Direct inguinal ≈ 2 : 1",
  "Bimodal age incidence: peak at 0–5 years, then 70–80 years",
  "40% of femoral hernias present as emergencies (strangulation)",
  "~2% of incisional hernias are strangulated at presentation",
  "Umbilical hernias: ~15% of emergency hernia surgery, 60% show strangulation at operation",
  "Source: Mulholland & Greenfield's Surgery 7e; Bailey & Love 28e",
], { fs: 17 });

// ── SECTION 4: CLASSIFICATION ───────────────────────────────────────────────
sectionDivider("04  Classification of Hernias");

tableSlide("Classification by Reducibility",
  ["Type", "Definition", "Emergency?"],
  [
    ["Reducible", "Contents return to abdomen spontaneously or with manual pressure", "No"],
    ["Irreducible / Incarcerated", "Contents cannot be returned; no vascular compromise", "Urgent – may become emergency"],
    ["Obstructed", "Incarcerated bowel causing intestinal obstruction", "Yes – urgent surgery"],
    ["Strangulated", "Vascular supply compromised → ischaemia/necrosis", "YES – immediate surgery"],
    ["Sliding", "Part of the sac wall is formed by a viscus (e.g. caecum, sigmoid)", "Risk of inadvertent injury at repair"],
  ]
);

tableSlide("Classification by Site",
  ["Region", "Types"],
  [
    ["Groin", "Inguinal (direct/indirect), Femoral, Pantaloon (both)"],
    ["Anterior abdominal wall", "Umbilical, Para-umbilical, Epigastric, Spigelian"],
    ["Incisional", "Through any previous surgical scar"],
    ["Rare / Special", "Obturator, Sciatic, Lumbar (Petit, Grynfeltt), Perineal"],
    ["Internal", "Paraduodenal, Foramen of Winslow, Mesenteric, Iatrogenic (post Roux-en-Y)"],
    ["Diaphragmatic", "Hiatal (sliding/rolling), Bochdalek, Morgagni, Traumatic"],
  ]
);

// ── SECTION 5: INGUINAL HERNIA ──────────────────────────────────────────────
sectionDivider("05  Inguinal Hernia");

twoColSlide("Direct vs Indirect Inguinal Hernia",
  [
    "Enters through the DEEP (internal) inguinal ring",
    "Congenital – patent processus vaginalis",
    "More common (2× direct)",
    "Younger patients",
    "Risk of strangulation HIGHER",
    "Comes down into the scrotum",
    "Controlled by pressure over deep ring (ring occlusion test)",
    "Lies lateral to inferior epigastric vessels",
    "Complete: descends into scrotum",
    "Bubonocele: confined to inguinal canal",
  ],
  [
    "Pushes through HESSELBACH'S TRIANGLE",
    "Acquired – weakness of transversalis fascia",
    "Less common",
    "Older males (>40 yrs)",
    "Risk of strangulation LOWER",
    "Rarely descends to scrotum",
    "NOT controlled by ring occlusion",
    "Lies medial to inferior epigastric vessels",
    "Usually broad-necked → less strangulation risk",
    "Often bilateral ('saddle-bag')",
  ],
  "◀  INDIRECT",
  "DIRECT  ▶"
);

contentSlide("Inguinal Hernia – Special Eponyms", [
  "Amyand's hernia – appendix in the hernia sac (described 1735)",
  "Littre's hernia – Meckel's diverticulum in the sac",
  "Maydl's hernia (hernia-en-W) – two loops of bowel in sac, intermediate loop strangulates intraperitoneally",
  "Richter's hernia – only part of the bowel wall (antimesenteric) is caught → no full obstruction; early gangrene",
  "Pantaloon hernia – concurrent direct + indirect hernia straddling inferior epigastric vessels",
  "Sliding hernia – posterior sac wall composed of viscus (caecum, sigmoid, bladder)",
  "Bilocular / Saddlebag hernia – bilateral direct hernias",
]);

// ── SECTION 6: FEMORAL HERNIA ───────────────────────────────────────────────
sectionDivider("06  Femoral Hernia");

contentSlide("Femoral Hernia – Key Points", [
  "Passes through the femoral ring into the femoral canal → exits via saphenous opening",
  "ALWAYS below and lateral to the pubic tubercle (inguinal hernia is above and medial)",
  "More common in women (but a woman with groin hernia is still 5× more likely to have inguinal)",
  "Femoral hernias are more common in older patients and post-inguinal hernia repair",
  "Narrow rigid neck → 40% present as EMERGENCIES with strangulation",
  "Contents: omentum, small bowel; may show Richter's hernia (partial bowel entrapment)",
  "Treatment: always operate (watchful waiting is NOT recommended) due to high strangulation risk",
  "Approaches: Low (Lockwood), High/transinguinal (Lotheissen), Preperitoneal (McEvedy/laparoscopic)",
]);

// ── SECTION 7: OTHER ABDOMINAL WALL HERNIAS ─────────────────────────────────
sectionDivider("07  Other Abdominal Wall Hernias");

contentSlide("Umbilical & Para-umbilical Hernias", [
  { text: "True umbilical hernia (children)", subs: ["Through umbilical cicatrix", "Common (especially Afro-Caribbean)", "90% close spontaneously by age 5 – conservative management up to age 5", "Repair if persists beyond 5 yrs, symptomatic, or defect >1.5 cm"] },
  { text: "Para-umbilical hernia (adults)", subs: ["Through linea alba adjacent to umbilical scar", "More common in obese, multiparous women", "Risk of strangulation ~15–60%", "Repair always recommended – Mayo repair (overlapping layers) or mesh"] },
]);

contentSlide("Epigastric, Spigelian & Incisional Hernias", [
  { text: "Epigastric hernia", subs: ["Through defects in linea alba between xiphoid and umbilicus", "Extraperitoneal fat protrudes – often no true sac", "Frequently missed clinically; may cause marked pain disproportionate to size", "Repair: simple suture or mesh for larger defects"] },
  { text: "Spigelian hernia", subs: ["At lateral edge of rectus abdominis, at level of arcuate line", "Always interparietal (beneath external oblique) → rarely visible", "High strangulation risk; US/CT for diagnosis", "Repair: open or laparoscopic"] },
  { text: "Incisional hernia", subs: ["10–20% after laparotomy; reduced to <5% with prophylactic mesh", "Risk factors: wound infection, obesity, malnutrition, steroids, midline incision", "Low spontaneous strangulation rate (~2%) – but repair recommended for symptomatic", "Repair: open mesh (sublay preferred) or laparoscopic IPOM/eTEP"] },
]);

// ── SECTION 8: SPECIAL HERNIAS ──────────────────────────────────────────────
sectionDivider("08  Special / Rare Hernias");

contentSlide("Rare Hernias – Quick Reference", [
  { text: "Obturator hernia", subs: ["Through obturator foramen", "Elderly, thin women (drainpipe sign)", "Howship-Romberg sign: pain on medial thigh (obturator nerve compression)", "Presents as SBO; CT diagnosis; very high mortality"] },
  { text: "Sciatic hernia", subs: ["Through greater or lesser sciatic foramen – extremely rare", "Can compress sciatic nerve"] },
  { text: "Lumbar hernia", subs: ["Petit's triangle (inferior) or Grynfeltt's triangle (superior)", "May be congenital or acquired (post-surgery/trauma)"] },
  { text: "Perineal hernia", subs: ["After abdominoperineal resection or levator ani defect"] },
  { text: "Hiatal hernia", subs: ["Sliding (95%): GEJ slides into thorax → GORD", "Rolling/para-oesophageal (5%): fundus herniates alongside GEJ", "Diagnosis: barium swallow / endoscopy", "Treatment: lifestyle + PPI; surgery for symptomatic rolling hernia (risk of volvulus)"] },
]);

// ── SECTION 9: CLINICAL FEATURES ────────────────────────────────────────────
sectionDivider("09  Clinical Features & Diagnosis");

contentSlide("Clinical Presentation", [
  "Groin/abdominal lump – exacerbated by coughing, straining, Valsalva; reduces on lying down",
  "Dragging discomfort or heaviness; sharp pain if nerve involved",
  "Referred pain: scrotum, inner thigh (ilioinguinal / genitofemoral nerve)",
  "Incarcerated hernia: tender, irreducible lump, ± features of bowel obstruction (vomiting, distension, constipation)",
  "Strangulated hernia: painful, tense, erythematous swelling; fever; signs of peritonitis/sepsis",
  "Silent hernias: discovered incidentally on imaging or at examination",
  "Symptoms that demand further workup: change in bowel habits, haematuria, weight loss (exclude malignancy)",
]);

contentSlide("Physical Examination", [
  "Patient examined STANDING first – increases IAP to reveal the hernia",
  "Inspect: asymmetric groin bulge, visible cough impulse",
  "Palpation: advance index finger through scrotum toward external ring, ask patient to cough (Valsalva)",
  "Reducibility: can contents be gently returned to abdomen?",
  "Ring occlusion test: compress deep ring → indirect hernia controlled; direct hernia not controlled",
  "Key landmarks: pubic tubercle – inguinal hernia is above and medial; femoral hernia is below and lateral",
  "Transillumination: bright in hydrocele (cannot transilluminate hernia)",
  "Examine contralateral side for bilateral hernia",
  "ALWAYS examine for lymphadenopathy – differential includes inguinal lymph nodes",
]);

// ── SECTION 10: COMPLICATIONS ───────────────────────────────────────────────
sectionDivider("10  Complications: Incarceration & Strangulation");

contentSlide("Incarceration vs Strangulation", [
  { text: "Incarceration (Irreducibility)", subs: ["Contents cannot be returned to abdomen", "No vascular compromise YET", "May be chronic (large hernia with wide neck) or acute", "Management: attempt gentle taxis/reduction in mild cases; elective repair within 24–48 hrs"] },
  { text: "Strangulation", subs: ["Vascular supply cut off at the neck of the hernia", "Venous obstruction first → oedema → arterial occlusion → ischaemia → gangrene", "Signs: severe unrelenting pain, tender hard mass, skin erythema, fever, toxicity, peritonism", "Requires EMERGENCY surgery", "Bowel resection if ischaemic/gangrenous"] },
  { text: "Obstruction", subs: ["Hernia as cause of acute SBO – especially femoral/inguinal", "Up to 75% of incarcerated hernia surgeries reveal intestinal ischaemia"] },
]);

contentSlide("Strangulation – Surgical Priorities", [
  "Do NOT attempt reduction under anaesthesia if strangulation suspected (risk of reducing dead bowel)",
  "Resuscitate: IV fluids, NG tube, analgesia, IV antibiotics",
  "Emergency surgery: reduce contents, assess bowel viability",
  "Bowel viability assessment: peristalsis, colour (pink vs grey/black), pulsation of mesenteric vessels",
  "'Second look' laparotomy if viability uncertain after 20 minutes warm saline packs",
  "Mesh use in contaminated field: avoid synthetic mesh if bowel resection; consider biological mesh or primary repair",
  "Mortality: significantly higher for emergency vs elective repair – underlines importance of early elective repair",
]);

// ── SECTION 11: INVESTIGATIONS ──────────────────────────────────────────────
sectionDivider("11  Investigations");

contentSlide("Investigations", [
  { text: "Usually clinical diagnosis – NO investigation needed for typical inguinal hernia", subs: [] },
  { text: "Ultrasound", subs: ["First-line imaging if clinical doubt", "Dynamic US with Valsalva: demonstrates hernia contents", "Differentiates hernia from hydrocele, lymph node, lipoma of cord"] },
  { text: "CT Abdomen / Pelvis", subs: ["Best for obese patients, emergency presentations, suspected internal hernia", "Identifies incarcerated / strangulated contents, detects complications", "Essential for rare hernias (obturator, sciatic, Spigelian)"] },
  { text: "MRI", subs: ["Superior soft-tissue contrast for sportsmen's hernia / athletic pubalgia", "Identifies subtle defects in abdominal wall musculature"] },
  { text: "Herniography", subs: ["Intraperitoneal contrast injection – largely superseded by CT/MRI"] },
  { text: "Pre-operative bloods", subs: ["FBC, U&E, coagulation – especially for emergency cases"] },
]);

// ── SECTION 12: OPEN REPAIR ─────────────────────────────────────────────────
sectionDivider("12  Surgical Repair – Open Techniques");

contentSlide("Principles of Hernia Repair", [
  "Fundamental steps: reduction of sac contents → ligation/excision of sac → repair of defect",
  "Two broad strategies:",
  "     ▸ Tissue repair (sutured): approximates native tissue layers – tension may lead to recurrence",
  "     ▸ Mesh repair: reinforces defect without tension – lower recurrence, preferred in adults",
  "Tension-free repair (Lichtenstein 1989) is the gold standard for open repair of inguinal hernia",
  "Mesh material: polypropylene most common; partially absorbable, biological, or composite meshes available",
  "EHS 2018 Guidelines: recommend mesh-based repair for all adult inguinal hernias",
]);

tableSlide("Open Repair Techniques – Summary",
  ["Technique", "Type", "Key Feature", "Use"],
  [
    ["Bassini (1887)", "Tissue", "Triple layer: transversalis fascia, internal oblique, conjoint tendon to inguinal ligament", "Historical; largely replaced"],
    ["Shouldice (1945)", "Tissue", "4-layer continuous overlapping repair of posterior wall", "Best tissue repair; still used in dedicated centres"],
    ["Lichtenstein", "Mesh (flat)", "Tension-free polypropylene mesh over posterior wall; slit around cord", "Most common open repair globally"],
    ["Plug & patch", "Mesh", "Plug into defect + flat mesh overlay", "NOT recommended by EHS 2018 (meshoma risk)"],
    ["Stoppa / preperitoneal", "Mesh", "Giant prosthetic reinforcement of visceral sac via midline incision", "Recurrent hernias; precursor to laparoscopic approach"],
    ["Lockwood", "Tissue/mesh", "Low approach for femoral hernia", "Femoral hernia"],
    ["McEvedy", "Tissue/mesh", "High extraperitoneal approach for femoral", "Emergency strangulated femoral hernia"],
    ["Mayo repair", "Tissue", "Overlapping ('vest over pants') layers", "Para-umbilical hernia"],
  ]
);

// ── SECTION 13: LAPAROSCOPIC REPAIR ─────────────────────────────────────────
sectionDivider("13  Surgical Repair – Laparoscopic Techniques");

twoColSlide("TEP vs TAPP – Laparoscopic Inguinal Hernia Repair",
  [
    "Totally Extraperitoneal (TEP)",
    "──────────────────────────",
    "Entirely preperitoneal – peritoneum NOT entered",
    "3 ports in midline",
    "Balloon dissection of preperitoneal space",
    "10×15 cm mesh in preperitoneal plane",
    "No peritoneal closure needed",
    "Lower risk of intraperitoneal injury",
    "Technical learning curve steeper",
    "Mesh fixation may not be required",
    "Contraindicated after previous preperitoneal surgery",
  ],
  [
    "Transabdominal Preperitoneal (TAPP)",
    "──────────────────────────",
    "Enters peritoneal cavity first",
    "3 ports (one umbilical)",
    "Peritoneal flap raised to access preperitoneal space",
    "10×15 cm mesh placed; peritoneum re-closed",
    "Can inspect contralateral side",
    "Easier if adhesions from previous surgery",
    "Allows concurrent laparoscopy",
    "Risk of port-site hernia",
    "EHS recommends either for bilateral / recurrent hernias",
  ],
  "◀ TEP", "TAPP ▶"
);

contentSlide("Laparoscopic vs Open Repair – Evidence Summary", [
  "Both laparoscopic (TEP/TAPP) and open (Lichtenstein) have comparable recurrence rates",
  "Laparoscopic advantages: less chronic groin pain, faster return to work and daily activities",
  "Lichtenstein advantages: shorter operative time, can be done under local anaesthesia, lower cost",
  "Chronic pain: most common complication of Lichtenstein – up to 20% (nerve entrapment: ilioinguinal, genitofemoral, lateral cutaneous femoral)",
  "Laparoscopic preferred for: bilateral hernias, recurrent hernias (after open repair), female patients",
  "Open preferred for: anaesthetically unfit patients, previous extensive preperitoneal surgery",
  "EHS 2018 guidelines endorse both approaches; choice depends on surgeon expertise",
  "Robotic repair: emerging; outcomes similar to laparoscopic with higher cost",
]);

// ── SECTION 14: COMPLICATIONS OF REPAIR ─────────────────────────────────────
sectionDivider("14  Complications of Repair");

twoColSlide("Complications of Inguinal Hernia Repair",
  [
    "EARLY",
    "• Haematoma / wound haematoma",
    "• Seroma (fluid collection)",
    "• Wound infection (1–2%)",
    "• Urinary retention (especially spinal/GA)",
    "• Ileus",
    "• Injury to bladder (rare)",
    "• Injury to vas deferens",
    "• Ischaemic orchitis (0.3–0.5%) → testicular atrophy",
  ],
  [
    "LATE",
    "• Hernia recurrence (1–3% with mesh)",
    "• Chronic groin pain (up to 20% open mesh)",
    "   - Nociceptive / neuropathic",
    "   - Ilioinguinal, genitofemoral, lat. cut. femoral nerves",
    "• Meshoma (solid mesh plug)",
    "• Mesh erosion / migration",
    "• Dysejaculation",
    "• Hydrocele",
    "• Testicular descent / retraction",
  ],
  "Early Complications", "Late Complications"
);

contentSlide("Chronic Pain After Hernia Repair", [
  "Most common long-term morbidity – affects quality of life significantly",
  "Incidence: up to 20% after open Lichtenstein; lower after laparoscopic TEP/TAPP",
  "Types:",
  "     ▸ Nociceptive somatic: mesh-related (meshoma, migration, excessive fixation)",
  "     ▸ Nociceptive visceral: cord or testicular structures involved",
  "     ▸ Neuropathic: nerve entrapment (ilioinguinal, iliohypogastric, genitofemoral)",
  "Prevention: meticulous nerve identification and preservation, fibrin glue fixation vs tacking",
  "Fibrin glue fixation: significantly lower chronic pain vs tacker fixation (RR 4.64 with tackers; Schwartz 11e)",
  "Treatment: physiotherapy, neuropathic analgesia, nerve block, surgical neurolysis/mesh removal",
]);

// ── SECTION 15: SPECIAL SITUATIONS ──────────────────────────────────────────
sectionDivider("15  Special Situations & Paediatric Hernias");

contentSlide("Paediatric Inguinal Hernia", [
  "Incidence: 4% of all infants; highest in premature (up to 30%) and low birth-weight males",
  "Almost exclusively INDIRECT (patent processus vaginalis)",
  "M:F = 6:1; right > left (2:1); bilateral in 10%",
  "Contents: small bowel, omentum; in girls – ovary (prolapsed ovary requires URGENT repair)",
  "Presentation: intermittent groin swelling worse with crying/straining",
  "Complications: incarceration is more common in infants (up to 30% in first year of life) – can compromise testicular blood supply",
  "Treatment: prompt elective surgical repair (high ligation of sac); no mesh required in children",
  "Herniotomy = ligation of sac at internal ring only (no floor repair needed in children)",
  "Patent processus also → hydrocele (transilluminates, non-reducible, non-tender)",
]);

contentSlide("Pregnancy & Hernia | Emergency Presentations", [
  { text: "Hernia in Pregnancy", subs: ["Increased IAP → umbilical hernias common, may worsen inguinal hernias", "Repair usually deferred until after delivery unless complicated", "Emergency incarceration: immediate surgical repair regardless of gestation"] },
  { text: "Emergency / Strangulated Hernia", subs: ["Femoral > inguinal > umbilical (by strangulation risk)", "Urgent resuscitation → emergency surgery", "No attempt at 'taxis' (forced reduction) if strangulation suspected", "Bowel resection if gangrenous; avoid synthetic mesh in contaminated field – use biological mesh or primary repair"] },
  { text: "Watchful Waiting", subs: ["Randomised trials: watchful waiting acceptable for minimally symptomatic male inguinal hernia", "Risk of acute emergency during watchful waiting: ~0.18/100 person-years", "Most develop symptoms requiring surgery within 5–7 years; early repair generally preferred"] },
]);

// ── SECTION 16: SUMMARY ─────────────────────────────────────────────────────
sectionDivider("16  Key Points & Summary");

contentSlide("Key Points – Must Know for Exams", [
  "Hernia = protrusion of a viscus through a wall defect; three parts: sac, contents, coverings",
  "Inguinal hernias = 75% of all abdominal hernias; M > F 10:1; indirect > direct 2:1",
  "Indirect: lateral to inferior epigastric vessels; passes through deep ring; controlled at deep ring",
  "Direct: Hesselbach's triangle; medial to epigastric vessels; NOT controlled at deep ring",
  "Femoral: BELOW inguinal ligament; narrow neck → 40% strangulate; always operate",
  "Strangulation = surgical emergency; most common with femoral hernia",
  "Richter's hernia = partial bowel wall entrapment → NO obstruction, but rapid gangrene",
  "Lichtenstein = most common open repair; TEP/TAPP = laparoscopic gold standard",
  "EHS 2018: mesh repair for all adult inguinal hernias; fibrin glue preferred over tacker fixation",
  "Chronic pain = most common late complication (up to 20% open mesh)",
  "Children: herniotomy only (high ligation of sac); no floor repair needed",
]);

contentSlide("Summary Mnemonics & Quick Reference", [
  "🔑 'MDs DIRECT patients' – Medial = Direct hernia",
  "🔑 Deep ring occlusion test: INDIRECT controlled, DIRECT not controlled",
  "🔑 FEMORAL = below and lateral to pubic tubercle; INGUINAL = above and medial",
  "🔑 Richter: partial bowel wall → NO full obstruction, EARLY gangrene",
  "🔑 Maydl's: hernia-en-W → middle loop strangulates inside abdomen",
  "🔑 Amyand's = appendix in hernia sac",
  "🔑 Howship-Romberg = medial thigh pain → obturator hernia",
  "🔑 Hesselbach's triangle: lateral rectus | inguinal lig | inf. epigastric vessels",
  "🔑 Emergency repair in strangulation: avoid synthetic mesh if bowel resection done",
]);

// CLOSING SLIDE
const closing = pres.addSlide();
closing.background = { color: NAVY };
closing.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.18, fill: { color: GOLD }, line: { type: "none" } });
closing.addShape(pres.ShapeType.rect, { x: 0, y: 5.44, w: 10, h: 0.18, fill: { color: TEAL }, line: { type: "none" } });
closing.addText("Thank You", { x: 0.5, y: 1.5, w: 9, h: 1.2, fontSize: 60, bold: true, color: WHITE, align: "center", fontFace: "Calibri" });
closing.addShape(pres.ShapeType.rect, { x: 2.5, y: 2.7, w: 5, h: 0.08, fill: { color: GOLD }, line: { type: "none" } });
closing.addText("Questions & Discussion", { x: 0.5, y: 2.9, w: 9, h: 0.6, fontSize: 24, color: LGRAY, align: "center", italic: true, fontFace: "Calibri" });
closing.addText([
  { text: "References: ", options: { bold: true, color: LGRAY, fontSize: 14 } },
  { text: "Bailey & Love's Short Practice of Surgery 28e  •  Schwartz's Principles of Surgery 11e  •  Mulholland & Greenfield's Surgery 7e  •  EHS International Guidelines 2018", options: { color: LGRAY, fontSize: 13 } }
], { x: 0.5, y: 3.9, w: 9, h: 0.9, align: "center", fontFace: "Calibri" });

// ── WRITE FILE ───────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/hernia-seminar/Hernia_Seminar.pptx" })
  .then(() => console.log("SUCCESS: Hernia_Seminar.pptx written"))
  .catch(err => console.error("ERROR:", err));

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/hernia-seminar/hernia.js'