inguinal hernia made easy
TRANSCRIPT
Waqas Khan
INGUINAL HERNIA
LAYOUT• Definition• Prevalence• Anatomy• Etiology• Types• Clinical Features• Differential Diagnosis• Management
DEFINITION
The word hernia is derived from a Greek word "hernios" meaning a bud," related to hira "intestine“.Hernia: A general term referring to a protrusion of a tissue through the wall of the cavity in which it is normally contained. Also known as rupture.
PREVALANCE
• 150,000-500,000 hernias repaired annually in U.S
Anatomy Composition:• The Sac• The Coverings• The Contents
Continued…
Myopectineal Orifice of Fruchaud
The Myopectineal Orifice is bordered: • Superiorly: Fibers of Internal• Oblique and Transversus
Abdominus Muscles (conjoint tendon).
• Medially: Rectus Abdominus Muscle and Rectus Sheath
• Inferiorly: Coopers Ligament
Continued…
• Laterally: Illeopsoas Muscle Contents:
The inguinal ligament runs diagonally through the orifice
Continued…
Hesselbach's triangle
ETIOLOGY
Predisposing factors :• Smoking • Age • Steroids • Immunosuppressive Medication • Collagen disorders • Surgical Wounds
Continued…
• Heavy object lifting • Obesity • Constipation • Coughing • Difficulty urinating
Types of Inguinal Hernias
It has three main types
1. Direct Inguinal Hernia2. Indirect Inguinal Hernia3. Pantaloon
Hernia(combination of both direct and indirect type)
DIRECT INGUINAL HERNIA
INDIRECT INGUINAL HERNIA
CLINICAL FEATURES
• Bulge in the inguinal region• Pain or vague discomfort • Extreme pain in strangulation• Paresthesias if inguinal nerves
are compressed
Clinical Examination
Physical exam:• The patient should be standing
and facing the examiner• Visual inspection may reveal a
loss of symmetry in the inguinal area or bulge
Continued…
• Valsalva’s maneuver or cough may accentuate the bulge
• Then ring occlusion test is performed to differentiate between direct and indirect hernia.
Differences
COMPLICATIONS
• Incarceration • Strangulation • Erosion of hernia sac through
weak skin
DIFFERNTIAL DIAGNOSIS
In Males• Hydrocele • Encysted hydrocele of cord• Spermatocele • Femoral hernia • Undescended testis• Lipoma of the cord
Continued…
In Females• Hydrocele of the canal of Nuck • Femoral Hernia
MANAGEMENT
Available options• Conservative Treatment• Surgical Treatment
Conservative TreatmentSupport• Truss• Binder
Not used commonlyss, binder)
Surgical Treatment
• Hernias have been documented throughout history with varying success at either reduction or repair
Continued…
It includes• Open Repair • Laparoscopic Repair
Specific Open Surgical Procedures
• Lichenstein (Tension Free) Repair
• McVay (Cooper’s Ligament) Repair• Halstead’s Repair
• Shouldice (Canadian) Repair
• Bassini Repair
Lichtenstein Repair
McVay Repair
Shouldice Repair
Bassini Repair
Laparoscopic Hernia RepairCurrent techniques include
• Transabdominal pre-peritoneal repair (TAPP)
• Totally extra peritoneal approach (TEPA)
TAPP Repair
TEPA Repair
Contraindications to Laproscopy
Contraindications:• large inguinoscrotal hernias• previous abdominal surgeries
MESH
Types of Mesh: A. Synthetic: • Absorbable: Vicryl® & Dexon® • Non-absorbable: Prolene® &
Gortex®
Continued…Biologic:
B. Biologic:
MESH LOCATIONS
INTRA-OP COMPLICATIONS
• Injury to Vas deferens• Injury to viscus ( Colon ad
bladder)• Bleeding
POST-OP COMPLICATIONS
Classified into three type• Immediate• Early• Delayed
Immediate Complications
• Primary hemorrhage• Basal atelectasis• Shock• Complications of Anasthesia
Early Complications• Secondary hemorrhage• Wound dehiscence• Urinary tract infection• Postoperative wound infection• Bowel obstruction due to fibrinous
adhesions
Delayed• Bowel obstruction due to fibrous
adhesions• Persistent sinus• Recurrence • Keloid formation
Take Home Message• Early diagnosis and prompt
treatment should be done in order to avoid complications
• Education of the patients so that they can get themselves treated in time
THANK YOU