Beruflich Dokumente
Kultur Dokumente
DEFINITION :
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)
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
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 :
TREATMENT :
S EE SHOULDICE, 1945
multilayer repair
recurrence rate < 1%
complicated
extensive dissection
1987 : Gilbert
Transperitoneal / preperitoneal
FEMORAL HERNIA :
Incidence :
Female : Male = 4/1
Multiparous woman
Elderly woman
Frequent complications : Strangulation,
Richters hernia
Treatment : Mc Vay Herniorraphy
UMBILICAL HERNIA
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 :
paraduodenal
mesenteric
Foramen of Winslow Hernias
Diaphragmatic hernia
TERIMA KASIH