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HERNIA

Dr. Pirma Hutauruk Sp(K)Trauma,ICS


SMF Bedah RS UD H. Abdul Muluk Bandar Lampung

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.

TYPES OF HERNIAS OF ABDOMINAL


WALL

INGUINAL ABDOMINAL WALL


Indirect inguinal, Direct inguinal,
Femoral
ANTERIOR ABDOMINAL WALL
Umbilical, Epigastric, Spigelian,
Supravesical
PELVIC
Obturator, Sciatic, Perineal
LUMBAR
Superior lumbar triangle (Grynfelt)
Inferior lumbar triangle (Petit)

ANATOMY OF ABDOMINAL WALL :

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
Weakness of muscle &
aponeurotic tissues ~ time (age)

TYPES OF INGUINAL HERNIA :

CLINICAL MANIFESTATIONS :

Predisposition : occupation
weight lifting
Local symptoms:
reducible - irreducible lump
groin discomfort, pain
Systemic symptoms: Cardinal signs
of obstruction
Colicky abdominal pain,
vomiting, abdominal distention,
and constipation.

CLINICAL GRADING

Grade

Reduction

reponible
+
irreponible
incarceration strangulation increase
leucocytosis

pain Obstruction toxic

colic
steady

++

PHYSICAL EXAMINATION

Position
Temperature
Pain
Size
Shape
Tensile strength
Composition (solid, gas, liquid)
Changes with cough

DIFFERENTIAL DIAGNOSIS

Femoral hernia
Vaginal hydrocele
Hydrocele of cord / canal of Nuck
Undescended testis
Lipoma of the cord

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

EDUARDO BASSINI HERNIORHHAPY

CHESTER B MCVAY, MD, PHD


1940 (COOPERS LIGAMENT REPAIR)

S EE SHOULDICE, 1945

multilayer repair
recurrence rate < 1%
complicated
extensive dissection

TENSION FREE = MESH GRAFT

1987 : Gilbert

GER 1990, VELEZ UND KLEIN 1990


LAPAROSCOPIC INGUINAL HERNIA REPAIR

Transperitoneal / preperitoneal

FEMORAL HERNIA :

Incidence :
Female : Male = 4/1
Multiparous woman
Elderly woman
Frequent complications : Strangulation,
Richters hernia
Treatment : Mc Vay Herniorraphy

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

VENTRAL HERNIA

Incisional
hernia : post
operative
Predispostion :
wound
infection
faulty
technique
wound
dehiscence

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
DRE : hernial lump

Sciatic hernia
Th/: operative

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

TERIMA KASIH

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