TEKNIK OPERASI

HERNIA

OLEH : ANGKATAN 2A
DEFINISI

Hernia didefinisikan sebagai suatu

protusi sebagian organ atau jaringan
melalui dinding yang menampung
organ dan jaringan tersebut
Hernia is the protrusion of a viscus or part of a viscus through
an abnormal opening in the walls of its containing cavity
Bailey and Love 22th edition ;Chapter 55

.
Composition of a hernia.
1. The sac : consisting of
mouth, neck, body and
fundus
2. The contents of the sac.
 LAPISAN DINDING ABDOMEN

1. Skin
2. Subcutaneus fat
3. External oblique muscle
4. Internal oblique muscle
5. Transversus abdominis muscle
6. Transversalis fascia
7. Subperitoneal fat
8. Peritoneum
 Insidensi

 Sekitar 75% dari hernia abdominal terjadi pada inguinal. Risiko

seumur hidup dari hernia inguinalis adalah 27% pada pria dan
3% di perempuan.
 Dari operasi hernia inguinal, 90% dilakukan pada pria dan 10%
pada wanita.
 Tipe hernia yang terbanyak terjadi di pria dan wanita adalah
hernia inguinalis indirek (HIL)

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 ETIOLOGI
Weakness due to structures entering and
leaving the abdomen
 Developmental failures
 Genetic weakness of collagen
 Sharp and blunt trauma
 Weakness due to ageing and pregnancy
 Primary neurological and muscle diseases
 Excessive intra-abdominal pressure
Williams, Norman S., Christopher JK Bulstrode, and P. Ronan
O'connell. Bailey & Love's short practice of surgery. Crc Press,
ANATOMI
ANATOMY
The inguinal canal is an approximately 4 to
6 cm long coneshaped region situated in
the anterior portion of the pelvic basin

The boundaries of the inguinal canal are :

• external oblique aponeurosis anteriorly,
• The internal oblique muscle laterally
• the transversalis fascia and transversus
abdominis muscle posteriorly
• the internal oblique muscle superiorly, and
• the inguinal (Poupart’s) ligament
inferiorly
 INNERVASI
Regio inguinalis dipersarafi oleh
nervus ilioinguinalis dan nervus
iliofemoralis yang mempersarafi otot
inguinal, sekitar kanalis inguinalis,
funikulus spermatikus, serta
sensabilitas kulit region inguinalis,
skrotum dan sebagian kecil kulit
tungkai atas bagian proksimomedial.
VASCULIRISASI

• Regio inguinalis
mendapat vaskulirisasi
dari A. External iliac.
yang bercabang menjadi
A,V iliaca femoralis dan
A,V iliaca eksterna.
Hernia femoralis
Lokasi: medial dari vena
femoralis
didalam lakuna vasorum
dorsal dari
ligamentum inguinal
sering dijumpai pada wanita
tua
sering mengalami
inkarserasi

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 KLASIFIKASI NYHUS HERNIA LIPAT PAHA

Type I--indirect inguinal hernia

Internal inguinal ring normal (i.e., pediatric hernia)
Type II--indirect inguinal hernia
Dilated internal inguinal ring with posterior inguinal wall intact
Type III--posterior wall defects
Direct inguinal hernia
Indirect inguinal hernia: dilated internal ring with large medial encroachment on
the transversalis fascia of the Hesselbach's triangle (i.e., massive scrotal, sliding hernia)
Femoral hernia
Type IV--recurrent hernia

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 JENIS-JENIS HERNIA
Reponibel Nyeri Obstruksi Terlihat sakit Toksik
Dapat + - - - -
direduksi
Tak dapart - - - - -
direduksi
Inkaserata - + + + -
Gangguan - ++ + + ++
vaskularisa
si

A : Hernia reponible
B : Hernia Irreponible
C : Hernia Inkarserata
D : Hernia Strangulata
PERBEDAAN HIL & HIM
BEDA HIL HIM

 Lokasi thd arteri Lateral Medial

epigastrika inferior
Tempat keluar Kanalis inguinalis Segitiga Haselbach

Bentuk Lonjong (sosis) Bulat

Nama Lain Hernia indirek Hernia direk
Usia Anak & dewasa Dewasa
Penyebab Kongenital & Didapat

Didapat
Hernia scrotalis Bisa Tidak
Jenis operasi:
1. Herniotomi: isi kantung dikembalikan pintu/cincin ditutup
dilakukan pada anak- anak dikarenakan penyebabnya adalah
proses kongenital dimana prosesus vaginalis tidak menutup pada
proses desensus testikulorum
2. Herniorafi
isi kantung dikembalikan pintu/cincin ditutup kemudian dinding
belakang dari hernia disulam/dijahit untuk diperkuat
dilakukan pada orang dewasa dikarenakan penyebab hernianya
adalah karena kelemahan otot/fascia dinding belakang abdomen

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Dikenal beberapa teknik hernioraphy:
- Bassini , Ferguson, Halsted , McFay, Shouldice (Open Anterior repairs)
-Teknik Nyhus (iliopubic tract repair) -- open posterior repair.
-Teknik Lichtenstein dan Rutkow menggunakan suatu prostetik jaring-jaring
nonabsorbable. ) merupakan tension-free repair with mesh.
-Hernioraphy laparoskopi dilakukan dengan dua cara pendekatan operasi,
yaitu the transabdominal preperitoneal (TAPP) approach atau the total
extraperitoneal (TEP) approach

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OPERATION
TECHNIQUE
 PERSIAPAN ALAT

• Chlorhexidine • Bisturi no. 23

• Alkohol • Scalpel no. 4
• Betadine • Gunting fascia
• Kassa • Kocher
• Nelaton • Klem
• Kain steril + doek bolong • Gunting jaringan
• Kauter • Langen bag
• Suction • Babcock
• Doek klem • Benang safyl ( long absorbable , braided)
no, 3.0
• Ethibon
• Chromic 3.0
• Nylon 3.0 / monosyn 3.0
PAINTING +
DRAPPING
OPEN APPROACH

A skin incision, extending from

just below and medial to the
anterosuperior iliac spine to the
pubic spine, is made 2 to 3 cm
above and parallel to Poupart’s
ligament

The iliohypogastric and

ilioinguinal nerves are
identified and preserved.
Pubic tubercle is identified
and the cord structures are
atraumatically dissected

An indirect hernia sac will

generally be found on the
anterolateral surface of the
spermatic cord after division
of the cremasteric muscle in
the direction of its fibers
Zollinger, Robert. M. Zollinger’s Atlas of
Surgical Operation. Ed 9. 2011
Zollinger, Robert. M. Zollinger’s Atlas of
Surgical Operation. Ed 9. 2011
BASSINI REPAIR
 BASSINI REPAIR

Zollinger, Robert. M.
Zollinger’s Atlas of Surgical
Operation. Ed 9. 2011
 BASSINI REPAIR

Zollinger, Robert. M. Zollinger’s Atlas of

Surgical Operation. Ed 9. 2011
MCVAY REPAIR

Zollinger, Robert. M. Zollinger’s Atlas of

Surgical Operation. Ed 9. 2011
 REPAIR OF INGUINAL HERNIA
WITH MESH (LICHTENSTEIN)

A rectangular piece of polypropylene

mesh approximately 2½ to 3 cm by
8 to 10 cm in size is cut with a
lateral slit for the cord and a medial
blunt oval for the pubis
The mesh is positioned on the floor
of the canal with the tails
overlapping lateral to the internal
ring and cord.
A nonabsorbable suture anchors the
mesh to the pubic tubercle
POST OPERATIVE CARE

• Physical activity is restricted for an additional

few days. Many experience improvement
after 3 days, and some may drive or return to
light duty work after 7 to 10 days.

• Vigorous exertion, as in sports, is limited for 4

weeks, and extreme exertion should be
avoided
 COMPLICATIONS
• Hernia Recurrence
• Pain :
• Cord and testes injury 
ischemic orchitis / testicular
atrophy (within 1 week)
• Bladder injury
• Wound infection
• Seroma
• Hematoma
• Prosthetic complication :
contraction, erosion,
infection, rejection
 REFERENCE...

Brunicardi, Charles. Schwartz’s Principles of Surgery. Ed 10. 2015.

Mc Graw Hill. USA

Zollinger, Robert. M. Zollinger’s Atlas of Surgical Operation. Ed 9.

2011. Mc Graw Hill. USA