PR TO HERNIA ANGKATAN 1B (JAFAN)

1. Perbedaan hernia inkarserata dan strangulata

Incarcerated Hernia The physical examination differs between

• If the visceral contents of a hernial sac
do not easily reduce into the peritoneal
cavity.
 Pain out of proportion to examination
findings
 Fever or toxic appearance
 Pain that persists after reduction of
hernia.
Strangulated Hernia
• Symptoms of an incarcerated hernia
present combined with a toxic
appearance.
• Systemic toxicity secondary to ischemic
bowel is possible.
• Strangulation is probable if pain and
tenderness of an incarcerated hernia
persist after reduction.
Sumber : Kuber, Sachin. 2013. Hernia Surgery Simplified.
Jaypee Brothers Medical Publishers (P) Ltd. India : New
Delhi.
an incarcerated hernia and a strangulated
hernia. The incarcerated hernia may be
mildly tender due to venous congestion
from the tight defect. The strangulated
hernia will be tender and warm and
may have surrounding skin erythema
secondary to the inflammatory reaction
from the ischemic bowel. The patient with
the strangulated hernia may have a fever,
hypotension from early bacteremia, and a
leukocytosis. The incarcerated hernia
requires operation on an urgent basis within
6–12 hours of presentation. If the operation
is delayed for any reason, serial physical
examinations are mandated to follow any
change in the hernia site indicating the
onset of tissue loss. The strangulated
hernia clearly requires emergent operation
immediately following diagnosis.

Sumber : Zinner, Michael J, et al. 2013. Maingot’s

Abdominal Operation Twelfth Edition. McGraw-Hill
Companies : New York.

2. Kriteria viabilitas usus :

“When strangulation is present, the surgeon must determine the viability of the involved
intestine by taking into consideration these actors: (1) a cadaveric odor; (2) the presence of
bloody fluid indicating venous thrombosis; (3) Failure of peristalsis to progress over the involved
intestine; (4) loss of the normal luster and color of the serosal coat; and, most important of all;
and (5) absence of arterial pulsation.”
Sumber : Zollinger, Robert. M. Zollinger’s Atlas of Surgical Operation. Ed 9. 2011

3. Innervasi n. ileohypogastric dan n. ileoinguinal

 Sumber : Moore, Keith L., et al. 2014. Moore Clinically Oriented Anatomy Seventh Edition. Lippincott Williams &
Wilkins : Philadelphia.
4. Teknik lain herniotomy selain dengan bridging :
 Teknik herniotomy in toto

Sumber : Zollinger, Robert. M. Zollinger’s Atlas of Surgical Operation. Ed 9. 2011

5. Indikasi dilakukan appendectomy pada hernia