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Definition :
Protrusion of abdominal content through a defect or weakness part on the abdominal wall Weak site : musculo -aponeurotic part Hernias consist of : ring sac content.
LUMBAR
Superior lumbar triangle (Grynfelt) Inferior lumbar triangle (Petit)
Inguinal Anatomy
Inguinal Hernia :
Incidence
Not known Western countries : 10-15%, Male : female = 12:1 Peak incidence : infant , adult : 40 - 60 years old Lichtenstein 1993: 700000 operations/year in USA
Etiology
Congenital or Acquired Three important factors
Existing preformed sac
Repetition of increased intraabdominal pressures
Clinical Manifestations :
Predisposition : occupation weight lifting Local symptoms:
reducible - irreducible lump
groin discomfort, pain
Clinical Grading
Reduction Grade reponible irreponible incarceration + colic + pain Obstruction toxic
strangulation
steady increase
++
leucocytosis
Physical Examination
Position Temperature Pain Size Shape Tensile strength Composition (solid, gas, liquid) Changes with cough
Differential Diagnosis
Femoral hernia Vaginal hydrocele
Treatment
Indication of Surgery
All groin/inguinal hernias
Minimal operative risks (~0)
Risk of untreated hernia : Strangulation with attendant risks concomitant medical problems do not preclude the need of undergoing surgery
Treatment :
1500 BC First reported case of groin hernia 700 AD Paul from Aegina
Hernial sac ligation Excision of hernial sac
Treatment :
1884 Edoardo Bassini (Italy)
Father of Modern Herniorrhaphy Dissection and reconstruction of the inguinal canal Splitting of obliqus externus aponeurosis Dissection & high ligation of hernial sacc Suturing the obl. int m., transv. Fascia, to inguinal ligament
S EE Shouldice, 1945
multilayer repair
recurrence rate < 1% complicated
extensive dissection
Femoral Hernia :
Incidence :
Female : Male = 4/1 Multiparous woman Elderly woman
Umbilical Hernia
Protrusion of abdominal content through the umbilical ring into the abdominal wall. Congenital defect
> 2 cm :
Regression (-) Often incarcerated Th/ : vest over pan, mesh graft
Epigastric hernia :
Protrusion of abdominal content through a defect in the linea alba. May mimic peptic ulcer Th/ reposition the sac, close the defect
Ventral Hernia
Incisional hernia : post operative Predispostion :
wound infection faulty technique wound dehiscence
obesity
malnutrition
Spigelian hernia :
Hernia at linea semilunaris Spigeli D/: USG Th/ Herniotomy and close the defect
Lumbar hernia :
Hernia :
Grijnfelt Petit
Th :
Herniotomy
Hernioplasty
Pelvic Hernia
Obturator hernia,:
Howship Romberg sign
Perineal hernia
protrusion of tissues through the muscles and fasciae of the pelvic diaphragm. Anterior hernia: labial, pudendal, or vaginolabial Posterior hernia Th:transabdominal
Other Hernias :
Littre Hernia, Scrotal hernia Internal Hernia :
paraduodenal
mesenteric Foramen of Winslow Hernias Diaphragmatic hernia
The end