HERNIA INGUINALIS

Dr. Argaputra Pradana

 Tujuan
1. Memahami dan mengerti hernia inguinalis.
2. Bisa menegakkan diagnosis Hernia inguinalis.
3. Mengerti alur penatalaksanaan hernia inguinal
4. Memahami dan mengerti kegawat daruratan
hernia inguinal
 Definisi
• Ruptur (latin)
• Kelemahan / disrupsi komplit dari jaringan
fibromuskuler dinding tubuh.1
• Defek  operasi.

Patrick J. Javid, jacob A. Greenberg, David C Brooks, Hernias, Maingot

abdominal operation, 12th, 123-
 Terminologi
• Reponible / reducible.
• Irreponible / irreducible
• Inkarserated
• Strangulated
• Permagna
 Epidemologi
• 700.000/ tahun
• Hernia inguinal (75%)
– 2/3 Indirect, remainder are direct
• Hernia insisional (15 - 20%)
• Umbilikal (10%)
• Femoral ( 5%)
• Prevalensi Hernia meningkat dengan
bertambah nya Umur
• Regio inguinal :
– Hernia inguinalis
• Indirect (lateral).
• Direct (medial).
– Hernia femoralis
ANATOMI
Inguinal Canal
• Between deep and
superficial inguinal rings

• Boundaries
– Superifical – external
oblique aponeurosis
– Superior – internal and
transversus
– Inferior – shelving edge of
inguinal ligament and
lacunar ligament
– Posterior (floor) –
transversalis fascia and
aponeurosis of transversus
abdominis muscle
 Etiologi
• Kongenital
• Didapat
– Operasi
– Peningkatan tekanan intra abdomen
• COPD , Acites, Kerja berat, konstipasi, BOO,
kehamilan.
• Gangguan metabolisme  Ehlers–Danlos
syndrome, Marfan’s syndrome, Hunter’s
syndrome, and Hurler’s syndrome
 Anamnesis
• Fundamental 4 + Secret 7
• F4 : RPS, RPD, RPD, RSE
• RPS : Keluhan utama, lokasi, onset,
kronologi, kwalitas, kwantitas, faktor
pemberat dan peringan, keluhan lain.
 Inguinal hernia

Male inguinal hernia Female inguinal hernia

• Physical Exam
• 74.5% sensitive and
96.3% specific
• examine the patient in
the standing and
supine positions.
• Finger test.
 Diagnosa banding
• Tendonitis
• Lymph node
• Lipoma
• Varicose vein
• Hydrocele
• Epididymitis
• Spermatocele
 Kegawatan hernia
1. Inkarserata
2. Strangulata
 obstruksi
HERNIA

Penumpukan sisa
makanan
Penekanan arteri
Fermentasi
H2S
Strangulasi Ischemia  nyeri
Distensi +++

Pemasangan
NGT, kateter Perforasi
Penumpukan cairan urethra
intra lumen

Rehidrasi cairan, Peritonitis

antibiotik
DEHIDRASI
Penatalaksanaan
 Penatalaksanaan
1. OPERASI
1. HERNIORAPHY
2. TANPA MESH ( Bassini, Souldice)
3. LAPAROSCOPY HERNIORAPHY
2. Mencari Etiologi.