Hernia Revision Dr.

Al -Matary

Hernia

brain hypoxia
lack of concentration

Break Irritability

Involuntary movement

Convulsion

Coma

convulsion
brain hypoxia shock brain hypoxia
coma convulsion irritability lack of concentration
involuntary movement

Page | 1
 Hernia Revision Dr. Al -Matary

Strangulated Hernia
Strangulated Hernia
strangulated

strangulation
Interference with the blood supply

Strangulation

blood supply strangulation volvulus

blood supply strangulation intussusception
mesentric vascular blood vessel shower of emboli A.F.
occlusion
interference with blood supply strangulation
strangulated hernia strangulation

strangulation strangulated hernia

interference with blood supply strangulation

strangulation strangulated hernia

strangulated hernia

defect

content

defect
content

defect
defect
strong sharp Narrow

narrow defect
examiner

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 Hernia Revision Dr. Al -Matary

sharp Narrow defect

defect

direct hernia
triangle of Hasselbach direct hernia

narrow external ring Internal ring oblique inguinal hernia

strong

Muscular adult
muscular adult
muscular adult

strong sharp narrow

Oblique inguinal hernia direct hernia

Oblique inguinal hernia

femoral hernia Oblique inguinal hernia

femoral hernia
pectineal ligament lacunar ligament inguinal ligament femoral hernia
very sharp narrow

adult

commonest strangulated hernia

femoral inguinal
More liable for strangulation femoral hernia

femoral hernia
Inguinal hernia commonest strangulated hernia

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Hernia Revision Dr. Al -Matary

strangulated hernia
strangulation strangulated hernia
Interference with blood supply strangulation

strangulation strangulated hernia

strangulated hernia

defect

content

strong narrow sharp defect

strangulation

content

content

content
hernia content
omentum Intestine

Omentum Intestine
Intestinal obstruction

strangulation without obstruction Omentum

strangulation with obstruction intestine

Omentum Intestine
vein artery
artery vein

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Hernia Revision Dr. Al -Matary

congestion

artery vein
congestion
vein artery
congested intestine

congested Intestine

vein
artery

Intestine artery

Intestine
bloody fluid

vein
artery

Once
blood
Pus
Infection sepsis

clinically
tense strangulated hernia

tense
cyst

tense hernia
tense hernia
tense tense tense tense hernia

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Hernia Revision Dr. Al -Matary

tense
clinically tense Hernia
tense

tense
tense
Pus

strangulated hernia
Pain
absolute constipation projectile vomiting

cardinal symptom pain

obstruction strangulation

strangulation without obstruction

pain

is painless condition unless complicated hernia

strangulation complication

absolute constipation Projectile vomiting

Intestine

absolute constipation projectile vomiting omentum

Littre's hernia Mickle's diverticulum

patent Lumen Mickle's diverticulum
absolute constipation projectile vomiting

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Hernia Revision Dr. Al -Matary

intestine lumen
Intestine

Richter's hernia
strangulation without obstruction
patent Lumen

strangulated hernia cardinal symptom

pain

absolute constipation Projectile vomiting

Strangulated omentum
Littre's hernia strangulated Mickle's diverticulum
Intestine lumen strangulated hernia Richter's type

examination
tense hernia
expansile impulse with cough

Local examination
Tense
expansile impulse with cough

Investigations strangulated hernia

clinical diagnosis
absolute constipation Projectile vomiting
erect Plane X - ray
Multiple fluid level

strangulated hernia commonest cause of intestinal obstruction

adult commonest cause by incidence of intestinal obstruction

strangulated hernia

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Hernia Revision Dr. Al -Matary

sophistication
Intestine duplex doppler
blood supply

Resuscitation
catheter cannula Ryle
Urgent
Intestinal obstruction
Ryle, catheter and fluid

lactated ringer Ryle

Cannula
analgesic antibiotic

antibiotic

analgesic
pain cardinal symptom
Pain cardinal symptom
analgesic

renal failure
shock

spinal general anesthesia

ileus spinal anesthesia
autonomic nervous system
ileus
general anesthesia

spinal anesthesia general anesthesia

ileus autonomic nervous system spinal anesthesia

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Hernia Revision Dr. Al -Matary

anesthesia

Precautions
general anesthesia
adequate

adequate
sac exposure

sac complete exposure

Inguinal incision Inguinal Hernia
ingunioscrotal incision Inguinoscrotal hernia

Adequate
sac complete exposure

adequate incision

sac

Precautions
defect sac

defect sac
sac defect

defect sac

general anesthesia precautions

adequate incision Incision precautions
defect sac sac Precautions

multi loculated para umbilical hernia sac

Neck
fundus

fundus sac Oblique inguinal hernia

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Hernia Revision Dr. Al -Matary

fundus Oblique inguinal hernia

multi loculated sac Para umbilical hernia

loculi fundus
neck

general anesthesia Precaution

adequate incision Precaution
Neck funds defect sac sac Precaution

sac
content fluid suction
Hernia

content
content
defect defect

defect content

serosa Intestine
defect

defect Intestine
Intestine
defect

defect

strangulated omentum strangulation

Omentum
Healthy
Unhealthy
Omentum

gangerous Healthy omentum

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 Hernia Revision Dr. Al -Matary

Intestine content
gangerous healthy

healthy
Intestine double loop
Maydl's hernia Intestine double loop
one loop medial limbs

healthy intestine

double loop
medial limb Intestine double loop
limb
U double u

gangernous Intestine
large intestine small intestine

large small
gangernous small intestine
resection and anastomosis
gangernous large intestine
left right
right
right side resection anastomosis
right hemicolectomy right side
ilio transverse anastomosis
ileum transverse colon
typical right colon blood supply
right colon resection anastomosis blood supply
blood supply gangrene
ileum transverse colon right colon

Left side

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Hernia Revision Dr. Al -Matary

colostomy Colostomy

Exterioriztion Colostomy
separate incision

hernia

Exterioization
proximal and distal colostomy

closure of the colostomy

colostomy
colostomy

herniate colostomy colostomy

Prolapsed Hernia colostomy colostomy

colostomy

herniorrhaphy herniotomy

Never hernioplasty

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Hernia Revision Dr. Al -Matary

gangernous large intestine

resection anastomosis

exteriorization + colostomy

happy surprise

Herniorraphy herniotomy
herniopalsty but never

never hernioplasty
Potentially infected defect
defect

potentially infected

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Hernia Revision Dr. Al -Matary

potentially infected defect foreign body

potentially infected defect

17
47

2007 47
strangulated hernia

inguinal hernia
Inguinal Hernia
femoral sheath Inguinal canal anatomy

Inguinal hernia

inguinal hernia
Inguinal canal Hernia

Inguinal canal
cord
cord
Inguinal hernia

Inguinal hernia
inguinal canal Hernia

Inguinal canal

cord inguinal canal

oblique inguinal hernia

cord Inguinal canal

direct hernia triangle of Hasselbach

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 Hernia Revision Dr. Al -Matary

Operative
oblique inguinal hernia
sac cord canal
sac
Pale, whitish in color
herniotomy neck
sac

cord oblique inguinal hernia sac

direct hernia
cord sac cord canal
versi strain
verse Invagination

verse invagination verse straining

neck
triangle of Hasselbach

direct inguinal hernia oblique inguinal hernia

direct inguinal hernia Oblique inguinal hernia

Pantaloon hernia

sac sac
pantaloon hernia sacs

Inguinal hernia
cord sac Oblique inguinal hernia
cord sac direct hernia
pantaloon direct inguinal hernia Oblique inguinal hernia
hernia

Oblique inguinal hernia

Oblique Inguinal Hernia
Processus vaginalis oblique inguinal hernia

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Hernia Revision Dr. Al -Matary

structure cord
structure cord

arteries
Nerves
structures

structures
Vas
Obliterated processus vaginalis
Pampiniform plexus of veins

Processus vaginalis testis

Lumbar embryo testis
Processus vaginalis scrotum
Patent processus vaginalis
Patent
Obliterated processus vaginalis obliteration

Hernia
Hernia due to patent processus vaginalis

Normal person Processus vaginalis

tunica vaginalis scrotum testis

covering covering testis

tunica vasculosa
thickened posteriorly tough tunica albuginea
Lobules testis fibrous septa mediastinum testis
Processus vaginalis tunica vaginalis
embryo testis

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 Hernia Revision Dr. Al -Matary

acquired pulsion sac

hernia
congenital
acquired pulsion sac

congenital
patent processus vaginalis

acquired pulsion sac

Hernia Processus vaginalis

external oblique muscle

Insertion origin
Outer surface of lower 8 ribs
outer lip of iliac anterior superior iliac spine Linea alba xiphoid process Insertion
pubic tubercle crest

insertion

aponeurotic Lower

pubic tubercle anterior superior iliac spine

Inguinal canal fold

Inguinal ligament
Insertion Origin
external oblique muscle
Internal oblique muscle

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 Hernia Revision Dr. Al -Matary

Internal oblique
conjoined tendon transverse abdominis muscle
tendon
origin
Origin
lateral 1/2 of upper surface of inguinal ligament Internal oblique
lower 6 costal cartilage , xiphoid process and linea alba

lateral 1/3 of upper surface of inguinal ligament and lower 6 transverse abdominis muscle
costal cartilage
xiphoid process and linea alba

medial lateral
conjoined tendon
Inguinal canal
fold

canal inguinal ligament fold external oblique

canal

fascia
fascia transversalis fascia

internal inguinal ring fascia Hernia

external inguinal ring canal
Oblique inguinal hernia

fascia tranversalis
acquired pulsion sac
Internal ring acquired pulsion sac
Under cover of internal spermatic fascia
cord
cord acquired pulstion sac

oblique inguinal hernia

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Hernia Revision Dr. Al -Matary

patent processus vaginalis congenital

acquired pulsion sac
cord

structures cord Patent processus vaginalis

vestige

structure cord acquired pulsion sac

structure
acquired pulsion sac

dating since birth Patent processus vaginalis

vestige

Patent processus vaginalis

dating since birth
adult

Patent processus vaginalis

dating since birth
adulthood

adulthood

Processus vaginalis
complete
testis Complete
testis intestine

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 Hernia Revision Dr. Al -Matary

Separated from the testis by interval

complete

funicular scrotum neck

inguinal region mass bulge inguinal canal Limited Hernia

Bubonocele

oblique inguinal hernia

oblique inguinal hernia

acquired pulsion sac

congenital
patent processus vaginalis
complete
funicular Neck of the scrotum
Bubonocele

pathology
Infantile sac funicular bubonocele
Clinically
bubonocele
funicular

infantile sac
separated from the testis by interval hernia
clinically bubonocele
funicular sac

oblique inguinal hernia

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Hernia Revision Dr. Al -Matary

oblique inguinal hernia

Acquired pulstion sac
congenital

processus vaginalis
Processus vaginalis
cord

acquired pulsion sac processus vaginalis

congenital processus vaginalis

Congenital
Congenital patent processus vaginalis
Dating since birth or later on in life

complete type
scrotum intestine

Bubonocele
funicular

Passing through the processus vaginalis

testis Complete
scrotum Neck funicular
Inguinal canal bubonocele

Infantile sac

Infantile sac
Inguinal canal bubonocele
scrotum Neck funicular

Oblique inguinal hernia cord hernia

cord acquired
cord congenital

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Hernia Revision Dr. Al -Matary

Processus vaginalis cord acquired

processus vaginalis cord congenital

direct inguinal hernia

Direct Inguinal Hernia
triangle of Hasselbach direct hernia
cord

triangle of Hasselbach

anterior superior iliac spine Pubic tubercle Inguinal ligament

triangle

Linea alba

iliac crest Inguinal ligament Internal oblique muscle

inguinal canal arch
arch
arching fibers
Insertion
Conjoint tendon

Nerve supply Internal oblique

Lower 6 intercostal nerves
ilio inguinal ilio hypogastric arching fibers

Lower 6 intercostal nerves Internal oblique

arching fibers
Ilio hyogastric
Ilio inguinal

Internal ring fascia transversalis

Inferior epigstric artery artery medial
rectus sheath

Internal ring fascia transversalis cord

arcuate line rectus sheath Inferior epigastric artery
rectus sheath arcuate line rectus sheath
external iliac artery inferior epigastric artery

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 Hernia Revision Dr. Al -Matary

external iliac artery Inferior epigastric artery

triangle of Hasselbach
Inferior epigastric artery
Inguinal ligament
lateral border of rectus sheath
triangle of Hasselbach

Inferior epigastric artery

Inguinal ligament
lateral border of rectus sheath

triangle of Hasselbach boundaries

triangle of Hasselbach
lateral border inguinal ligament Inferior epigastric artery triangle of Hasselbach
of rectus sheath

conjoint tendon fascia transervalis

Posterior wall of inguinal canal

direct hernia
fascia transversalis
conjoint tendon

fascia transversalis

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Hernia Revision Dr. Al -Matary

fascia
conjoint tendon

fascia
: direct hernia
Lateral type
Medial type

aging
lateral type
fascia transversalis

direct hernia

Medial type
appendicectomy
conjoint tendon ilio inguinal nerve

type
type conjoint tendon

Inguinal hernia
Oblique inguinal hernia
Direct inguinal hernia

cord Oblique inguinal hernia

triangle of Hasselbach cord direct inguinal hernia

oblique inguinal hernia

due to patent processus vaginalis congenital
acquired pulsion sac acquired

due to patent processus vaginalis congenital

complete
infantile sac

Page | 24
 Hernia Revision Dr. Al -Matary

infantile
bubonocele
funicular

direct hernia
triangle of Hasselbach direct hernia

lateral type
medial type
aging lateral type
conjoint ilioinguinal nerve medial type
tendon
type

conjoint tendon external oblique

external ring conjoint tendon

external oblique
conjoint tendon

ilioinguinal nerve
conjoint tendon
type

conjoint tendon type

external oblique muscle
scrotum external ring

Lateral type
external oblique

scrotum

scrotum lateral type

external oblique aponeuroesis scrotum

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 Hernia Revision Dr. Al -Matary

scrotum type
external ring scrotum
scrotum

oblique inguinal hernia

anatomy Operative

inguinal hernia
Oblique inguinal hernia
direct inguinal hernia

cord oblique inguinal hernia

Congenital
acquired
cord

cord direct hernia

direct hernia
Medial type
lateral type

conjoint tendon medial type

fascia transversalis Lateral type

type conjoint tendon medial type

scrotum external ring

scrotum external oblique apoenuroesis lateral type

Obliterated lateral umbilical ligament lateral type medial type

Obliterated lateral umbilical ligament Ligament

obliterated lateral umbilical ligament

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Hernia Revision Dr. Al -Matary

Umbilical artery
internal iliac artery

Umbilical artery internal iliac

umbilical artery
medial conjoint tendon
Lateral conjoint tendon

painless condition unless complicated hernia

is painless condition unless complicated hernia

Hernia
expansile impulse with cough reducible swelling
anatomical site of hernia

is painless condition unless complicated hernia

expansile impulse with cough reducible swelling Hernia
anatomical site of hernia

anatomical site
Ingunial canal

direct hernia
expansile impulse with cough reducible Swelling
Inguinal canal

oblique inguinal hernia

expansile impulse with cough reducible Swelling
Inguinal canal

type rare scrotum direct hernia

type rare scrotum direct hernia

scrotum Oblique inguinal hernia

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Hernia Revision Dr. Al -Matary

Internal ring test

expansile impulse with cough reducible swelling Hernia

anatomical site

Inguinal canal Inguinal hernia

indirect direct
type rare scrotum direct inguinal hernia
scrotum Oblique inguinal hernia

direction of reduction
direct backward reducible direct inguinal hernia

Upward and laterally Oblique inguinal herina

Upward and laterally reducible oblique inguinal hernia

cord

cord
Downward and medially

Downward and medially

Upward and laterally

scrotum oblique inguinal hernia

scrotum cord cord
cord oblique inguinal hernia Key
Oblique inguinal hernia

downward and medially

cord

scrotum
cord

Upward and laterally reducible

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Hernia Revision Dr. Al -Matary

cord

Inguinal canal cord

Internal ring
internal ring canal cord
Internal ring

Internal ring
Oblique inguinal hernia

cord oblique inguinal hernia Password

downward and medially
cord
Upward and laterally
cord
cord scrotum
scrotum cord

Oblique inguinal hernia

Internal ring

Internal ring

Internal ring canal cord

internal ring Oblique inguinal hernia

sac
Internal ring Neck

Internal ring direct hernia

triangle of Hasselbach
cord Internal ring

Internal ring

indirect direct pantaloon hernia

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 Hernia Revision Dr. Al -Matary

clinically
Oblique inguinal hernia Indirect hernia direct pantaloon hernia
clinically
Internal ring
direct

Indirect
pantaloon hernia

pantaloon hernia

direct hernia
cord prophylactic

direct hernia
versi strain sac invagination

cord
Oblique inguinal hernia
missed sac
missed sac recurrence

direct hernia oblique inguinal hernia

direct hernia Inguinal canal

cord direct hernia

19
cord Oblique inguinal hernia
triangle of Hasselbach cord direct inguinal hernia

direct hernia canal

Oblique inguinal hernia

cord

direct hernia

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Hernia Revision Dr. Al -Matary

oblique inguinal hernia empirically cord

direct hernia oblique inguinal hernia

triangle of Hasselbach

oblique inguinal hernia treatment

Treatment

surgical oblique inguinal hernia

Liver cirrhosis
Oblique inguinal hernia
liver cirrhosis
decompensation Liver

Oblique inguinal hernia

anesthetic Liver cirrhosis
local anesthesia

Oblique inguinal hernia

child C ascites
Ascites

ascites control ascites

ascites control

ascites to control

survival

strangulated hernia ascites

ascites
local anethesia

Page | 31
Hernia Revision Dr. Al -Matary

oblique inguinal hernia

border line Liver

elective

Investigations

Lichtenstein repair

shouldice Bassini repair Marcy's rpair

sac

Urgent

mortatlity Investigations

Liable for strangulation Oblique inguinal hernia

surgery Main line of treatment oblique inguinal herina

Herniotomy

Herniorrhaphy
Bassini repair shouldice repair

Hernioplasty
tension three mesh Lichtenstein

hernioplasty

Darning
Grafting

Darning

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Hernia Revision Dr. Al -Matary

Grafting

natural
skin Fascia lata

skin
Implantation dermoid cyst

synthetic
synthetic

mersalin prolene
prolene

colonization of bacteria
mersalin

PTFE
fibrosis double face
fibrosis
PTFE
Operative

operative fascia transversalis

Inguinal canal Posterior wall
fascia transversalis
operative

fascia transveraslis

fascia transversalis shouldice repair fascia transversalis

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Hernia Revision Dr. Al -Matary

fascia transversalis sandwitched

Operative

sac invagination

fascia transversalis

fascia transversalis
shouldice fascia transversalis
double shouldice
fascia transversalis

fascia transversalis

fascia transversalis
onlay

laparoscope

sublay
sublay

Onlay lay

treatment of direct inguinal hernia

direct inguinal hernia
type of patient

liable for strangulation direct inguinal hernia

oblique inguinal hernia

Oblique inguinal hernia

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Hernia Revision Dr. Al -Matary

treatment of precipitating factor

hernioplasty herniorrhaphy Herniotomy

Liver cirrhosis Oblique inguinal hernia

Treatment of precipitating factor
hernioplasty defect Herniorrhaphy Herniotomy

ascites liver cell failure oblique inguinal hernia

ascites
Precipitating factor
Hernioplasty defect Hernirrhaphy herniotomy

Heart failure oblique inguinal hernia

Heart failure control
Herniplasty herniorrhaphy herniotomy

very bad prognosis ascites

local anethesia
mortality

direct hernia

not liable for strangulation direct inguinal hernia

liable for strangulation

cost benefits

Liable for strangulation hernia

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Hernia Revision Dr. Al -Matary

direct hernia

direct inguinal hernia

direct inguinal hernia

ilioinguinal nerve
direct hernia
direct hernia

direct hernia

oblique inguinal hernia

Surgical

Liable for strangulation

Liver cirrhosis
Surgery
ascites
surgery ascites Control
surgery sugery Surgery

Liable for strangulation Hernia

direct hernia attitude

general condition
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Hernia Revision Dr. Al -Matary

truss

Proced

Multi system affection

Once

pantaloon hernia Dual hernia

Intra operative diagnosis
Indirect direct
internal ring test clinically
Intra operative sure diagnosis

Internal ring test clinically

Intra operative sure diagnosis

sliding hernia
Sliding Hernia
sliding hernia
Inguinal hernia hernia

sliding hernia
hernia

inguinal hernia sliding hernia

sliding femoral hernia

para umbilical hernia

sliding

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Hernia Revision Dr. Al -Matary

inguinal hernia sliding hernia

sliding inguinal hernia

Organ Organ
content sac Organ
sliding sac organ

content sac viscous

sliding hernia sliding sac defect

sliding hernia
sac defect viscous

defect
sac

defect
right side cecum
Left side pelvic colon
urinary bladder

right side cecum

Left side pelvic colon
urinary bladder

clinically

Long standing inguinal hernia

irreducible partially

urinary bladder sliding hernia

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Hernia Revision Dr. Al -Matary

double micturation

Intra operative sure diagnosis

sliding hernia
Long standing inguinal hernia
Partially irreducible
double micturation sliding urinary bladder
However
Intra operative sure diagnosis
sac viscous
sliding hernia

femoral hernia
Femoral Hernia
in females more common in males femoral hernia
females

Pregnancy

Wide pelvis
wide pelvis
wide femoral canal wide femoral sheath Wide pelvis

wide femoral canal wide femoral sheath Wide pelvis

femoral sheath
blood vessel femoral sheath

femoral sheath

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Hernia Revision Dr. Al -Matary

blood vessel
femoral sheath
Pregnancy
femoral hernia

left side right side femoral hernia

Pelvis diameters

femoral hernia
femoral ring Pathology

femoral canal femoral hernia

canal

Femoral ring

femoral canal

Saphenous opening

canal
femoral ring

dense fat fat

Femoral septum

saphenous opening canal

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Hernia Revision Dr. Al -Matary

saphenous opening
cribriform fascia

femoral ring
femoral canal
saphenous opening

fascia lata of the thigh Scarpa's fascia saphenous opening

femoral ring
femoral canal
saphenous opening

fascia lata of the thigh Scarpa's fascia

Downward
forward saphenous opening forward Downward

forward downward
saphenous opening

Upward
Upward

downward

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Hernia Revision Dr. Al -Matary

saphenous opening Downward and forward

forward
femoral canal
superficial depth

Downward and forward

femoral canal
downward and forward

Upward and laterally saphenous opening

downward and medially

backward
upward
upward backward

femoral hernia constricting agent

lacunar ligament
femoral ring
femoral ring
Inguinal ligament
lacunar ligament
Pectineal ligament

lacunar ligament inguinal ligament femoral ring

pectineal ligament
Liable for strangulation
ligaments
lacunar ligament

multi para
femoral hernia Upper thigh swelling Multi para

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 Hernia Revision Dr. Al -Matary

femoral hernia Upper thigh swelling Multi para

Multi para upper part of the thigh swelling

femoral hernia

upper thigh Multi para un explained pain

strangulated femoral herina

strangulated femoral hernia Pain Upper thigh

strangulated
anti mesentric border gangerene Richter type
Lumen
Intestinal obstruction

swelling
Multi para

obese

swelling Mulit para

femoral hernia

Unexplained pain
Richter type strangulated femoral hernia

Richter type strangulated femoral hernia

intestinal obstruction

swelling painful Multi para

strangulated femoral hernia pain swelling

Lymph node inflamed

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 Hernia Revision Dr. Al -Matary

inflamed Lymph node

Richter type strangulated femoral hernia Clinically

talent femoral hernia swelling

Richter type strangulated femoral hernia swelling pain

Richter variety strangulated

intestinal obstruction

expansile impulse with cough reducible swelling

anatomical site
downward reducible
backword
Upward

upward and forward downward

congenital
congenital

Oblique inguinal herina

right side oblique inguinal hernia

femoral hernia

femoral sheath anatomy

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Hernia Revision Dr. Al -Matary

femoral sheath anatomy

femoral hernia

congenital femoral hernia

full mark

full mard

full mark
full mark

femoral sheath Outside femoral hernia Cloquet's

Gimbert's ligament laugier's
lacunar Gimbert's ligament
Inguinal Poupart's
Inguinal ligament
Poupart's Inguinal ligament

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Hernia Revision Dr. Al -Matary

femoral canal anatomy

Cooper's pictneal ligament
Gimbert's lacunar liagment

MCQ

MCQ

hip dislocation
Narath
Narath sign

hip dislocation

Narath sign
pulse

Narath
Hip

femoral hernia congenital hip dislocation

Narath's sign

congenital femoral hernia

cloquet's
Narath
Laugier's

happy surprise

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Hernia Revision Dr. Al -Matary

congenital femoral hernia

Narath sign congenital hip dislocation

femoral sheath Outside

femoral sheath inside classic femoral hernia
Cloquet's type femoral sheath Outside congenital femoral hernia

congenital hip dislocation

Laugier
cloquet's

developmental dislocation of the hip

communicate

developmental hip dislocation

femoral hernia
How to investigate it

How to investigate femoral hernia

is a clinical diagnosis Hernia

How to investigate inguinal hernia

is a clinical diagnosis hernia
It does not need investigations
precipitating factor Investigations

femoral hernia
Treatment of precipitating factors

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Hernia Revision Dr. Al -Matary

hernioplasty defect Herniorrhaphy Herniotomy

umbilical hernia
Umbilical Hernia

umbilical hernia clinical

Umbilical hernia

congenital umbilical hernia

Placenta

umbilical cord placenta

anterior abdominal wall

anterior abdominal wall

anterior abdominal wall

Umbilica cord
Umbilical cord

amniotic membrane Warton jelly Umbilical cord

Umbilical cord

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Hernia Revision Dr. Al -Matary

fake

anterior abdominal wall

Umbilical cord

umbilical cord

umbilical cord

umbilical cord

Intestine

intestinal rotation Intestine

intestine
Umbilical cord

umbilical cord

scar umbilical cord

scar

umbilical scar umbilical stump

Linea alba Umbilical scar

linea alba umbilical scar

Umbilicus

umbilicus

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Linea alba umbilical scar

umbilical cord

scar
Umbilicus
Umbilicus

umbilical scar umbilicus

Linea alba

rare

Oh my God OMG
congenital umbilical hernia

congenital umbilical hernia

amniotic membrane

risky

skin best cover

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amniotic membrane umbilical cord

Undermining
Undermining
abdominal wall

Muscles

skin muscles
muscles

ugly scar healing

scar
Hernia
Intestine

Hernia scar
ugly scar Ugly scar

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abdomen
abdominal muscles

emergency Urgent

life saving manoeuvre skin Intestine

Exomphalus congenital umbilical hernia

congenital umbilical hernia

Exomphalus major
Exomphalus minor
defect
exomphalus minor exomphalus major
defect

exomphalus minor
exomphalus major

Liver
major Liver defect

minor
Liver

umbilical cord
eccentric cord cord exomphalus major

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Eccentric
cord defect
eccentric

associated congenital anomaly exomphalus

congenital umbilical hernia

exomphalus major
exmphalus minor

amniotic membrane
release incision

umbilicus defect
exomphalus

ectopia vasica

ectopia vascia Umbilicus Defect

exomphalus congenital umbilical hernia umbilicus
Gastroschisis Umbilicus

Infantile umbilical hernia

Infantile Umbilical Hernia
infantile umbilical hernia
Umbilical scar

Umbilical scar

Umbilical scar
Infantile umbilical hernia

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Umbilical scar

Intestine Infantile umbilical hernia

Umbilical scar
intestine

phimosis

phimosis
prepuce

prepuce

prepuce Penis
prepuce

circumcision

Phimosis
Prepuce

umbilicus

Infantile umbilical hernia

Infantile umbilical hernia

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umbilical scar

hernia

eczema
maceration

surgical

which is extremely extremely extremely extremely rare strangulated

strangulated

rare

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congenital inguinal hernia

congenital inguinal hernia

Congenital inguinal hernia

Liable for strangulation

Infantile umbilical hernia

Para umbilical hernia

Para Umbilical Hernia ( Adult Umbilical Hernia )
Para umbilical hernia

type of patient

Para umbilical hernia

mulit para Female
Muli para female

strangulated hernia
Hernia
diabetic keto acidosis
Intra cranial hemorrhage

type of patient risky patient Para umbilical hernia

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Para umbilical hernia risk

defect transverse colon
it means colostomy
Exteriorization

defect transverse colon

colostomy

risky para umbilical hernia

risky para umbilical hernia

Risky
hypertensive obese diabetic type of patient
colostomy defect transverse colon
Liable for strangulation Narrow sharp defect
liable for strangulation Narrow sharp defect

below the umbilicus umbilicus common above para umbilical hernia

Above

wide and weak W umbilicus above linea alba

Narrow umbilicus below Linea alba

defect below the umbilicus defect above

Clinical pictures
below umbilicus above Painless swelling

umbilicus Distorting
umbilicus evert

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Umbilicus umbilical hernia

umbilicus evert Umbilical hernia

umbilicus para umbilical hernia

umbilicus distort

Local examination
umbilicus Swelling above or below
irreducible Partially
Gives expansile impusle with cough

clinical pictures
partially irreducible Hernia

para umbilical hernia

sac

multi loculated sac

intestine intestine intestine intestine
Intestine

The commonest complications

irreducibility para umbilical hernia
Multi loculated sac

common
para umbilical hernia commonest complication
strangulation

para umbilical hernia commonest complication

irreducibility

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strangulation irreducibility

Irreducibility commonest complication Incidence

Multi loculated sac

irreducible Partially sac

Orange
Orange like
narrow defect defect
Liable for strangulation

Orange like

Narrow defect
Liable for strangulation

defect
Liable for strangulation defect

clinical pictures Prominent

Irreducible
Irreducible
multi loculated sac

reducible Hernia
irreducible
multi loculated sac

liable for strangulation

orange like

Narrow defect

intertrigo stretched

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intertrigo

Intertrigo
wound infection

treatment of precipitating factors

herniorrhaphy Herniotomy

N.B.
umbilicus common above Para umbilical hernia
linea alba

N.B.
Irreducibility commonest complication
Multi loculated sac

N.B.
hydrocele of hernia sac Para umbilical hernia

femoral inguinal

ascites Unless

Para umbilical hernia Hydrocele of hernial sac

epigastric hernia
Epigastric Hernia
epigastric hernia
blood vessel Linea alba

linea alba

Blood vessel

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epigastric hernia
blood vessels epigastric hernia

blood vessels
Multiple epigastric hernia

Multiple epigastric hernia

linea alba
blood vessels

epigastric hernia
epigastrium
Stomach

epigastrium

stomach epigastric hernia

greater omentum

dyspepsia

Pain related to meal

peptic ulcer dyspepsia

multiple epigastric hernia

blood vessels
greater omentum
pain related to meal greater omentum
dyspepsia

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fat epigastric hernia

early

fat

fatty hernia of linea alba

extra peritoneal fat

It does not give expansile impulse with cough

defect
fatty hernia of linea alba extra peritoneal fat
epigastric hernia

defect

extra peritoneal fat

expansile impulse with cough fatty hernia of linea alba

fatty hernia of linea alba

epigastric hernia

dyspepsia Omentum

defect
fatty hernia of linea alba extra peritoneal fat
epigastric hernia
dyspepsia Omentum

Treatment of precipitating factors

anatomical repair Mayo's repair Herniorrhaphy Herniotomy

epigastric hernia para umbilical hernia

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Interval
Umbilicus below Just above para umbilical hernia
separated from the umbilicus by interval epigastric hernia

incisional hernia
Incisional Hernia
clinical Incisional hernia

clinical Incisional hernia

recurrent hernia Incisional hernia

incisional reccurent

para umbilical hernia

Recurrent

Incisional
recurrent Incisional

scar hernia

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scar

Incisional hernia
type of patient

calculus obstructive jaundice chronic cholecystitis

charcot triad

obstructive jaundice

Hernia

intertrigo
wound infection

diaphragm

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15
15
15

15

diaphragm

intertrigo
ventilator Post operative ventilator

Intertrigo
post operative ventilator

type of patient
Incisional hernia

Intertrigo
ventilator

scar

secondary intention Healed Ugly scar

Incisional hernia Infection

examination History
Incisional hernia
History
Incisional hernia

incisional hernia

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 Hernia Revision Dr. Al -Matary

go ahead

anemic
Incidence of incisional hernia

Healing power

Hypo vitaminosis Malnutrition

Hepatosplenomegaly

incisional hernia

cause
healing delay diabetes ascites
cause
incisional hernia

intra operative

too loose too tight

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History

Hepatosplenomegaly

too tight
too loose
absorble sutures

Post operative
scar Wound infection
early return to work

Incisional hernia
clinical pictures
expansile impulse with cough reducible Painless swelling
scar

abdomen abdominal muscles scar

secondary intention Primary intention scar

blunt wide sharp small defect defect

sharp small
liable for strangulation

herniorrhaphy samll and sharp defect

wide and blunt defect

incisional hernia examination

secondary intention primary intention scar

wide and blunt narrwo and sharp defect

Liable for strangulation Narrow and sharp

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liable for strangulation wide and blunt

weak abdominal muscles

divercation of recti weak abdominal muscles
ascites hepatosplenomegaly

is a clinical diagnosis hernia

Does not need investigations

treatment of precipitating factor treatment

anatomical repair hernioplasty herniorrhaphy herniotomy

Hernia

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