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LISTEN CAREFULLY!!!!

A male patient is lying in bed in the hospital , wearing on oxygen mask over his
mouth and nose still heavily sedated from a difficult four hours surgical procedure.
A young student nurse appears to give him a partial sponge bath. Nurse he mumbles
from behind the mask “ Are my testicles black ?”
Embarrassed , the young nurse replies “ I don’t know sir, I’m only here to wash your
upper body and feet “ He struggles to ask again “ Nurse , are my testicles black ?”
Concerned that he may elevate his vitals from worry about his testicles , she
overcomes her embarrassment and sheepishly pulls the covers . She raises his
gown and holds his penis in one hand and his testicles in the other lifting and moving
them around. Then she takes a close look and says “ There’s nothing wrong with
them sir”
The man pulls off his oxygen mask , smiles at her and says very slowly “ Thank you
very much. That was wonderful but listen very closely ….”
“ Are…my …test…..results……back ….?”
ABDOMINAL AND INGUINAL
HERNIAS

LAMBERTO J. CAGINGIN , M.D. FPCS


DEPARTMENT OF SURGERY
DLSU-HSC
OBJECTIVES
To be able for the students to identify
the types of abdominal and inguinal
hernias

To be able to diagnose and advice the


proper treatment for such conditions

To be able to understand the kind of


surgery needed by these patients
ABDOMINAL
INCISIONAL
UMBILICAL
INGUINAL
INDIRECT
DIRECT
FEMORAL
SLIDING
PANTALOON
STAGES
 REDUCIBLE

 IRREDUCIBLE ( INCARCERATION )

 BOWEL OBSTRUCTION

 STRANGULATION
GOOD HISTORY IS A MUST ! ! !
- elicit the causative factor/s
- consider the time element
 PHYSICAL EXAMINATION :
- examine all symptomatic and asymptomatic
“ bulge” in the abdomen and groin
 - INSPECTION
 - PALPATION
 - TRANSILLUMINATION
 - D.R.E.( digital rectal exam )
DIAGNOSIS ( TSS )
INDICATE TYPE
 STAGE
 SITE
DIFFERENTIAL DIAGNOSIS
- RULE OUT OTHER PATHOLOGIES FOR
SCROTAL OR INGUINAL MASS AND
OTHER ASSOCIATED CONDITIONS !!!
DIFFERENTIAL DIAGNOSES
LIPOMA OF THE CORD
TESTICULAR TORSION
TESTICULAR TB
TESTICULAR ABSCESS
EPIDYDIMITIS / ORCHITIS
HYDROCOELLE
VARICOCOELLE
SEMINOMA
IDENTIFY OTHER CO MORBID
DISEASE CONDITIONS
 COPD
 PROSTATISM / BPH
 PROSTATIC CA
 HEMORRHOIDS
 RECTAL CA
TREATMENT
 HERNIORRHAPY- Non Prosthetic Anatomical repair
 A) Anterior Approach
 - Bassini , Halsted , Mcvay , Shouldice
 B) Pre peritoneal Approach

 HERNIOPLASTY – Prosthetic or Mesh repair


 A) Anterior Approach
 - Mesh Plug or Patch - Lichtenstein
 B) Pre peritoneal
 - Anterior or Posterior
 C) LAPAROSCOPIC

HERNIOTOMY
COMPLICATIONS
RECURRENCE
CHRONIC PAIN
SEROMA
HEMATOMA
VASCULAR
VISCERAL
SUMMARY
- A GOOD HISTORY AND P.E. IS
MANDATORY
- DIAGNOSE BY INDICATING T S
S
- CONSIDER YOUR
DIFFERENTIALS OR OTHER
ASSOCIATED DISEASE
CONDITIONS
- GIVE THE APPROPRIATE ADVICE
THANK YOU !!!