HERNIA

Dr.SUDARTANA,Sp.B-KBD
INGUINAL HERNIA
INCIDENCE:
- Hernia occur in 15 of 1000 individual
- 5% of all men during their lifetime
- 2/3 of in iguinal hernias a indirect
- A contralateral hernia is demonstrated
at presentation in 3% in patients with
inguinal hernias
TERMINOLOGY:
1. DIRECT HERNIA,are those in wich vis
cera protrude through a weak area in
posterior inguinal wall.The base of the
hernia sac is medial to the inferior epi
gastric vessels through HESSELBACH
TRIANGLE


Figure 1. Hesselbach's triangle. This anatomic landmark is
bounded by the rectus abdominis muscle medially, the
inguinal ligament inferiorly and the inferior epigastric
vessels laterally. The triangle is outlined in red.

2. INDIRECT HERNIA,pass through the
internal inguinal ring lateral to the
inferior epigastric vessels and lie within
the spermatic cord.The sac is covered
by the fibers of the cremaster muscle
3. PENTALOON HERNIAS <incombine>

3. RICHTER HERNIA, part [rather than
the entire circumference] of the bowel
wall is trapped.
4. LITTRES HERNIA, the content of
hernia is a Meckels Diverticulum.

5. REDUCIBLE HERNIA,contents of the
hernia will return easily to the peritoneal
cavity.
6. IRREDUCIBLE HERNIA,contents of her
nia canot return to the peritoneal cavity
and without symptom of intestinal
obstruction.
7. INCARCERATE HERNIA,contents of
hernia canot return to the peritoneal
cavity and with symptom of intestinal
obstruction.
8. STRANGULATED HERNIA,
incarcerated hernia + sign of strangu
lation

DIAGNOSIS:
1. CLINICAL PRESENTATION:
A.Symptoms:
- intermittent bulge that appears in
the groin
- unilateral discomfort
- rarely,bowel obstruction
B.PHYSICAL EXAMINATION:
- Palpation
- Finger test
- Zieman test
- Thumb test

2. RADIOGRAPHIC EVALUATION:
- X ray studies are rare indicated
- USG or CT may occasionally be used
for an occult groin hernia,particularly in
obese patients.
DIFFERENTIAL DIAGNOSIS:
- Femoral hernia
- Inguinal adenopathy
- Lipomas
- Dilatation of the saphenous vein
- Testicular torsion
- Groin abscess
THERAPY :
1. HERNIOTOMY
2. HERNIOPLASTY:
- Bassini Repair
- Mc Vay Repair
- Shouldice Repair
- Tension free Repair
- Preperitoneal Repair [by laparoscopic]