HERNIA
•
•
Hernia is define as the protrusion of a viscera or its part through a defect or weakness of the wall of
its cavity.
It can be divided into two categories:
–
–
INTERNAL HERNIAS e.g. cerebral herniation, diaphragmatic hernia, etc.
EXTERNAL HERNIAS e.g. inguinal hernia, umbilical hernia, etc.
ETIOLOGY:





•
Increase intra abdominal pressure due to:






Lifting heavy weight
Chronic cough
Obesity
Ascites
Pregnancy
Straining during defecation or micturation (BPH)
Intra-abdominal malignancy
Acquired weakness after trauma or previous surgery
Site of anatomical weakness
Smoking.
Hernia consist of sac, which is the diverticulum of peritoneum having following part:
–
–
–
•
•
•
•
•
•
•
•
FUNDUS: it is the first part to protrude out.
BODY: extends between fundus and neck containing contents
NECK: usually well defined, usually the narrowest part of the hernial sac
CONTENTS:
FLUID: ascites, exudate.
OMENTUM: omentocele
INTESTINE:
–
–
–
ENTEROCELE: containing gut
RICHTER’S HERNIA: contaning a portion of circumfrence of gut.
LITTRE’S HERNIA: containing meckel’s diverticulum.
BLADDER:
TYPES OF HERNIA:
REDUCIBLE HERNIA:
( when hernia sac comes and goes itself)
IRREDUCIBLE HERNIA:
(when hernia is unable to reduce)
OBSTRUCTED HERNIA:
(when signs of intestinal obstruction are present, abdominal pain, vomiting, distension and
constipation).
STRANGULATED HERNIA:
(when blood supply is compromised)
INGUINAL HERNIA
•
•
•
INGUINAL HERNIA:
It is defined as the protrusion of the viscera or the part of the viscera into the inguinal canal.
It is divided into two types
–
–
Indiect inguinal hernia
Direct inguinal hernia.
TYPES OF INGUINAL HERNIA:
1- INDIRECT INGUINAL HERNIA:
–
–
In this type of hernia the contents enter the inguinial canal through the deep inguinal ring or
lateral to inferior epigastric artery.
It can be of following types:
•
•
•
BUBONOCELE:
–
limited to inguinal canal
FUNICULAR:
–
it crosses the superficial inguinal ring but does no touch the base of scrotum.
COMPLETE:
–
reaches the base of the scrotum
2- DIRECT INGUINAL HERNIA:
–
In this type of hernia the contents enter the inguinal canal directly through the posterior wall
of the inguinal canal or medial to inferior epigastric artery.
–
–
Usually occurs in old age group’
It can be of following types:
•
•
•
INCOMPLETE: reaching upto the scrotum thought the superficial ring but not
reaching the base of scrotum
COMPLETE: reaching the base of scrotum (rare)
DUAL (saddle bag, pantaloon hernia) contains both the elements, one medially and
other laterally to the inferior epigastric artery.
TREATMENT:
•
•
•
•
•
•
•
•
HERNIOTOMY:
HERNEORAPHY:
–
–
–
–
LYTLES METHOD
SHOULDICE METHOD
DARNS REPAIR.
BASSINI’S REPAIR
HERNIO PLASTY:
–
LICHTENSTENE APPROACH
CONGINITAL INGUINAL HERNIA
A congenital inguinal hernia results from a patent processus vaginalis.
The defect can be large enough to allow abdominal or pelvic organs to descend.
It is the commonest reason for an operation in infancy and childhood.
The processus vaginalis is derived from a layer of peritoneum that the testis passes through after
12 weeks' gestation on route through the inguinal canal to the scrotum.
The processus vaginalis normally becomes obliterated around 32 weeks gestation.
•
•
•
•
However, if it persists then it extends as a hollow tube or sac of peritoneum that extends from the
external ring towards the external genitalia.
If the opening is narrow, it only allows peritoneal fluid to track down and manifest as a hydrocele.
If the opening is large then larger organs can descend along this pathway, e.g. intestines, and this
constitutes a hernia and manifests as a lump in the groin.
The factors causing obliteration of the sac are unknown.
TREATMENT:
•
•
If a hernia is diagnosed then the child should have surgery as soon as is convenient.
A herniotomy is performed - the patent part of the processus is isolated and tied off at the internal
ring and then the distal part is excised
UMBLICAL HERNIA
UMBLICAL HERNIA
•
•
•
•
Congenital umbilical hernia is a congenital malformation of the umbilicus.
Among adults, it is three times more common in women than in men; among children, the ratio is
roughly equal.
It is also found to be more common in children of African descent.
An acquired umbilical hernia directly results from increased intra-abdominal pressure caused by
obesity, heavy lifting, a long history of coughing, or multiple pregnancies
TREATMENT:
•
•
When the orifice is small(< 1 or 2 cm), 90% close within 3 years (some sources state 85% of all
umbilical hernias, regardless of size, and if these hernias are asymptomatic, reducible, and don't
enlarge, no surgery is needed (and in other cases it must be considered).
In some communities mothers routinely push the small bulge back in and tape a coin over the
palpable hernia hole until closure occurs. This practice is not medically recommended as there is a
small risk of trapping a loop of bowel under part of the coin resulting in a small area
of ischemic bowel. The use of bandages or other articles to continuously reduce the hernia is
not evidence based.
•
•
•
An umbilical hernia can be fixed in two different ways. The surgeon can opt to stitch the walls of the
abdominal or by placing mesh over the opening and stitch it to the abdominal walls.
The latter is of a stronger hold and is commonly used for larger2 defects in the abdominal wall.
Most surgeons will not repair the hernia until 5-6 years after the baby is born.
PARAUMBLICAL HERNIA
PARAUMBLICAL HERNIA
•
•
A paraumbilical (or para-umbilical) hernia is a protrusion of the intestines or gut into
the abdomen through a weak point of the muscles or ligaments near the umbilicus distorting its
shape.
It can lead to discomfort when fatty tissue gets trapped and a lump can be felt or seen. Whilst they
are not usually life-threatening, routine surgical treatment is usually advised to prevent enlargement
or strangulation of the gut.
TREATMENT:
•
•
HERNIORRHAPHY:
–
–
If the defect is small it can be repaired primarily with non absorbable suture.
Mayo’s repair can be done.
HERNIOPLASTY:
–
If the defect is more than 4 cm or in case of recurrent paraumblical hernias mesh can be
used.
EPIGASTRIC HERNIA
EPIGASTRIC HERNIA
•
•
An epigastric hernia is a type of hernia which may develop in the epigastrium (upper, central part
of the abdomen). Epigastric hernias usually appears in adults.
Unlike the benign diastasis recti, epigastric hernia may trap fat and other tissues inside the opening
of the hernia, causing pain and tissue damage
TREATMENT:
•
•
HERNIORAPHY:
–
If the defect is small and less than 4 cm.
HERNIOPLASTY:
–
–
If the defect is greater than 4 cm.
Prolene mesh is used.
INCISIONAL HERNIA
INCISIONAL HERNIA
•
•
This is a hernia through am acquired scar in the abdominal wall, usually caused by previous
surgical operation.
PREDISPOSING FACTORS:
–
–
–
–
–
–
Post operative abdominal distension
Ascites
Wound infection
Malnourished
Improper suture material or technique
Chronic cough
TREATMENT:
•
•
•
•
Traditional "open" repair of incisional hernias can be quite difficult and complicated. The weakened
tissue of the abdominal wall is re-incised and a repair is reinforced using a prosthetic mesh.
Laparoscopic incisional hernia repair is a new method of surgery for this condition.
The operation is performed using surgical telescopes and specialized instruments. The surgical
mesh is placed into the abdomen underneath the abdominal muscles through small incisions to the
side of the hernia. In this manner, the weakened tissue of the original hernia is never re-incised to
perform the repair, and one can minimize the potential for wound complications such as infections.
Laparoscopic repair has been demonstrated to be safe and a more resilient repair than open
incisional hernia repair.
THANK YOU!