Definition
A hernia is an abnormal protrusion
of any viscus from its proper
anatomical cavity through:
congenital defect
weakened region in its wall
Frequency
Groin
Indirect inguinal
Direct inguinal
Femoral
Incisional
Ventral
Epigastric
Umbilical
Spigelian
Others
Hiatal
Lumbar
Obturator
Perineal
Sciatic
Peristomal
75-80 %
60-65 %
15 %
5 %
10 %
10 %
5 %
Etiology
Congenital defects
Enlarged foramen
Loss of tissue strength and elasticity
Trauma
Increased intra-abdominal pressure
Descriptive terms
Reducible
Irreducible
Incarcerated
Strangulated
Complete
Incomplete
Sliding
Richters hernia
Maydls hernia
Littres hernia
Inguinal Anatomy.
Inguinal Anatomy..
Femoral hernia.
The hernia content
passes beneath the
inguinal ligament
traverses the femoral
canal
seen as a mass at the
level of foramen ovale
Femoral herni..
Incarceration* and strangulation* are
frequent (30-40%).
More common in women (1/3 of all groin
hernias) than in men (2% of all groin
hernias).
However, inguinal hernia is more frequent
both in men and in women than femoral
hernia.
Femoral hernias are related to physical
exertion and to pregnancy
Diagnosis.
History
Some patients may describe a sudden pain
and bulge while lifting, coughing or straining
(physical activity).
The mass may be
continiously
intermittantly present
In general, direct hernias
produce fewer symptoms than indirect
inguinal hernias
less likely to become incarcerated or
strangulated.
Diagnosis..
Physical examination
A mass may be
Visible
Tender
Reducible
Bowel sounds may be audible.
A mass may be
Small or nonpalpabl
Palpabl with coughing and straining.
Diagnosis...
Radiology
Plain films
Upper GI series
Contrast medium enema
Herniography
US
CT
MRI
Treatment.
Ideally, all hernias should be
treated surgically.
Because the risk of incarceration,
strangulation and obstruction are
greater than the risk of elective
operation
Treatment..
The principles of repair
ng Herni, D Uur
ng Herni, D Uur
Umbilical hernia
Umbilical hernias occur at the umbilicus.
10 times more often in women than in men.
The defect is common in children, but is
usually (95%) obliterated spontaneously.
In adults, umbilical hernias are often
associated with increased intra-abdominal
pressure (ascite, pregnancy, obesity, large
intra-abdominal tumor).
Treatment
Simple transverse repair of the fascial defect
(<3 cm).
Prosthetic material (tension-free repair)
(>3 cm / recurrent hernia).
Epigastric hernia
It develops through a
defect in the linea alba
above the umbilicus.
About 20% of epigastric
hernias are multiple
Treatment
Simple repair
10% recurrence rate
Prosthetic repair
For larger hernias
Incisional hernia
Results from poor wound healing in a previous surgical incision
90% are seen during first 3 years
Common etiologic factors:
Poor surgical technique
wound infection
wound hematoma
advanced age
Obesity
Malnutrition
increased postoperative abdominal pressure
(ileus, ascites, pulmonary complication)
Treatment
Primary repair (Recurrence rate is 25%)
Prosthetic repair (Open / laparoscopic)
Diaphragmatic hernias
Potential defects
Single
Esophageal hiatus
Paired
Posterolateral
(Bochdalek)
Anterior
(Morgagni, Larrey)
Treatment
Nissen, Toupet,
Belsey Mark IV
Primary/prosthetic repair