This document defines hernia and describes the different types. It begins by explaining that a hernia is an abnormal protrusion of an organ or tissue through a weakness in the wall of the cavity that normally contains it. It then discusses the causes of hernias including structural weaknesses, injury, and increased intra-abdominal pressure. The document categorizes hernias based on their reducibility, symptoms, and location. It provides detailed information on inguinal hernias including classifications and physical examination techniques. Finally, it outlines current management approaches for inguinal hernia repair including open and laparoscopic surgical techniques using mesh to reinforce weakened areas.
This document defines hernia and describes the different types. It begins by explaining that a hernia is an abnormal protrusion of an organ or tissue through a weakness in the wall of the cavity that normally contains it. It then discusses the causes of hernias including structural weaknesses, injury, and increased intra-abdominal pressure. The document categorizes hernias based on their reducibility, symptoms, and location. It provides detailed information on inguinal hernias including classifications and physical examination techniques. Finally, it outlines current management approaches for inguinal hernia repair including open and laparoscopic surgical techniques using mesh to reinforce weakened areas.
This document defines hernia and describes the different types. It begins by explaining that a hernia is an abnormal protrusion of an organ or tissue through a weakness in the wall of the cavity that normally contains it. It then discusses the causes of hernias including structural weaknesses, injury, and increased intra-abdominal pressure. The document categorizes hernias based on their reducibility, symptoms, and location. It provides detailed information on inguinal hernias including classifications and physical examination techniques. Finally, it outlines current management approaches for inguinal hernia repair including open and laparoscopic surgical techniques using mesh to reinforce weakened areas.
This document defines hernia and describes the different types. It begins by explaining that a hernia is an abnormal protrusion of an organ or tissue through a weakness in the wall of the cavity that normally contains it. It then discusses the causes of hernias including structural weaknesses, injury, and increased intra-abdominal pressure. The document categorizes hernias based on their reducibility, symptoms, and location. It provides detailed information on inguinal hernias including classifications and physical examination techniques. Finally, it outlines current management approaches for inguinal hernia repair including open and laparoscopic surgical techniques using mesh to reinforce weakened areas.
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DEFINITION & TYPES
OF HERNIA
1 “ ‘HERNIA’ Greek - an offshoot / bulge Latin - to tear / rupture An abnormal protrusion of an organ or part of an organ through a defect / weakness in the wall of the cavity normally containing it
Contents can be returned to Contents cannot be reduced The herniated part of bowel is the abdomen when given or pushed back into the irreducible but has good pressure on. abdomen but no complication. blood supply.
Mild / absent symptoms
Incarcerated Strangulated Sliding
Irreducible hernia with viable Visceral contents of hernia Part of a viscus (e.g. colon) is contents, used synonymously become twisted or entrapped adherent to the outside of the with obstructed hernia. by narrow opening peritoneum (extraperitoneal) forming the hernial sac Contents of the hernial sac Compromised blood supply, beyond the hernial orifice) are stuck to one another by ischaemic / necrotic contents adhesions Usually on the left. Painful / tender on palpation 4 COMPOSITION OF A HERNIA
Sac Covering of Contents of
the sac the sac Mostly the diverticulum of Composed of Depending on peritoneum the layers of the part of abdominal wall abdomen that is (Mouth, neck, through which herniated body, fundus) the sac passes. Omentum, intestines, etc.
INGUINAL HERNIAS ¾ of all abdominal wall hernias Indirect
9 DIRECT vs INDIRECT INGUINAL HERNIA
10 TYPES OF INDIRECT INGUINAL HERNIAS
1) Complete Hernia: Hernial 3) Bubonocele: Hernia does not
sac is patent up to the bottom come out of the superficial of the scrotum (males) inguinal ring and is limited to the or labia majora (females). inguinal canal.
2) Incomplete Hernia: The
process vaginalis sac is patent up to root of scrotum but it comes out through the superficial inguinal ring. 11 PHYSICAL EXAMINATION
Position of patient: First standing, then lie supine
Inspection: Palpation: Ring occlusion test: ▰Swelling: Pyriform shape ▰Non-tender unless strangulated ▰Differentiate indirect/direct extending down – indirect; ▰Granular (omentocele); elastic Method: Performed in standing circular shape – direct; (enterocele) position, ask patient to cough when spherical shape, starts from thumb is pressed on the deep below the inguinal ligament – Zieman’s Technique: inguinal ring - bulge medial to thumb femoral. ▰Differentiate (direct) ▰Skin: Normal (uncomplicated); direct/indirect/femoral erythema (strangulated) Percussion: Method: Place the index finger ▰Resonance (enterocele); dullness ▰Impulses on coughing: (indirect) over the deep inguinal ring (omentocele or fatty tissue) Momentary bulge (absent if neck the middle finger (direct) on the of the sac is obstructed ) superficial inguinal ring and the ring Auscultation: Not applicable finger (femoral) over the saphenous 12 opening and ask the patient to CLINICAL FEATURES
May be asymptomatic and found incidentally.
Site: Groin area Onset: Gradual / acute (incarceration) Character: Burning, gurgling, or aching pain with heavy or dragging sensation in the groin Radiation: Localized, may radiate to the scrotum Associated symptoms: Weakness in groin, (if strangulated) nausea & vomiting, fever and inability to pass gas / stool
13 CLINICAL FEATURES (continued)
Time / Duration: Constant, worse toward the end of the day or after prolonged activity Exacerbating factors: Worsen with Valsalva maneuvers. Activities that increase intra-abdominal pressure, i.e. coughing, lifting, or straining, cause more abdominal contents to be pushed through the hernia defect. Severity: Mild to severe Progression: Bulge of the hernia gradually increases in size, suddenly intensified pain may indicate strangulation * If bulge disappears while patient is in the supine position, clinical suspicion of a hernia should be increased.
14 MANAGEMENT OF INGUINAL HERNIA
Hernia repair techniques – indicated in irreducible, symptomatic cases
1) Open or conventional hernia repair 2) Laparoscopic hernia repair
Gold standard - Mesh Repair
▰ Hernioplasty – Herniotomy plus reinforcement of the posterior wall of the inguinal canal with a synthetic mesh ▰ Herniorrhaphy – Herniotomy plus repair of the posterior wall of the inguinal canal ▰ Herniotomy – Removal of hernia sac without any repair of the inguinal canal 15 * PHS – PROLENE hernia system
OPEN INGUINAL HERNIA REPAIR
Mesh inserted to cover and support the posterior inguinal canal. (Hernioplasty)
Before After
16 LAPAROSCOPIC INGUINAL HERNIA REPAIR Performed under GA, extra-/ trans-peritoneally. Not appropriate for large or irreducuble hernias.
17 ADVANTAGES OF REPAIR TECHNIQUES
▰ Laparoscopic repair: ▰ Open hernia repair:
▻ Faster recovery times ▻ Fewer internal injuries ▻ Less risk of long-term ▻ Lower recurrence pain rates in the context of primary inguinal ▻ Lower risk of another hernia hernia recurrence after a previous recurrence 18 THANK YOU! Any questions?
