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Hernia

Hernias occur when abdominal contents protrude through weak points or openings in the abdominal wall. There are several types of hernias that occur in different locations through the abdominal wall. Inguinal hernias are the most common, occurring either directly through the abdominal wall or indirectly through the internal ring. Femoral hernias occur below the inguinal ligament and are more common in females. Umbilical hernias occur through the linea alba at or near the umbilicus. Surgery is usually required to repair hernias by pushing the contents back in and reinforcing the weak area with sutures or mesh. Complications can include incarceration, strangulation, or bowel obstruction

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69 views8 pages

Hernia

Hernias occur when abdominal contents protrude through weak points or openings in the abdominal wall. There are several types of hernias that occur in different locations through the abdominal wall. Inguinal hernias are the most common, occurring either directly through the abdominal wall or indirectly through the internal ring. Femoral hernias occur below the inguinal ligament and are more common in females. Umbilical hernias occur through the linea alba at or near the umbilicus. Surgery is usually required to repair hernias by pushing the contents back in and reinforcing the weak area with sutures or mesh. Complications can include incarceration, strangulation, or bowel obstruction

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عبد المعطي الجماعي
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Hernias

Definition
Hernia is a protrusion of the contents of abdomen through an abnormal opening or weak
area in the abdominal walls .
May be external ( through abdominal wall )or intraabdominal ( like hiatus hernia )

1
There are weak points at abd wall that’s more liable to form hernias are:-
1- umbilicus
- scar of umbilical cord in embryo , lies in middle of abd. wall
2-inguinal canal
Its oblique intramuscular passage in the lower part of ant. Abd. Wall transmit
( spermatic cord in male or round legament. In female ),

Aetiology of hernias
a- congenital
undescending testis usually associated with inguinal hernia.
b- aquired
1- raises intra-abdominal pressure (ie. Whooping cough is a predisposing cause in
childhood , amongst smokers …)
2
2- Acquired collagen deficiency increasing an individual ’ s susceptibility to the
development of hernias
3—obesity and pregnancy due to :-
-- Stretching of the abdominal musculature because of an increase in contents,
-- Fat acts to separate muscle.
--A femoral hernia is rare in nulliparous women and men, but more common in
multiparous women owing to stretching of the pelvic ligaments.
4-after surgical operation(incisional hernia) wound is weakest area in abdominal wall

Composition of a hernia .
1-The sac
The sac is a diverticulum of peritoneum consisting of mouth, neck, body and
fundus.
2-The covering s are derived from the layers of the abdominal wall through which
the sac passes.
3-Contents
Commonly either omentum = omentocele ; Or intestine = enterocele.

Types of hernias

CLINICAL CLASSIFICATION OF HERNIA


1. Reducible Hernia
2. Irreducible Hernia
3. Obstructed Hernia
4. Inflamed Hernia
5. Strangulated Hernia

3
Groin hernias (inguinal, femoral)
1-Inguinal hernia
Indirect hernia
It comes out through internal ring along with the cord.
This is the most common type of hernia (65%).
It is more common in younger age group.
It is more common on right side

Direct hernia
It occurs through the posterior wall of the inguinal canal.
More in elderly
Usually bilateral

Differential diagnosis
The presentation of inguinal hernia either groin mass or scrotal swelling
Groin mass
• an encysted hydrocele of the cord; (move with pulling down of testis )
• a femoral hernia;
• an incompletely descended testis; ( empty scrotum )
• a lipoma of the cord
• LN.
Scrotal swelling
• hydrocele -- (can get above it. , trnslumination )
• spermatocele;

Treatment of inguinal hernia


Operative treatment. Either Open technique or laparoscopic
Types of operations
1- herniotomy ; just reduction of the contents and excising the sac
2- herniorrhaphy reduction of the contents , excising the sac and supporting the defect by
sutures.
3- hernioplasty; reduction of the contents excising the sac and support the defect with mesh.

Complication of mesh
1- infection
2- pain
3- erosion to adjacent organs

Contraindications of mesh
1- children
2- strangulated hernia
3- pregnancy

4
Femoral hernia
Common in females (2:1 ratio), common in multipara.
Rare before puberty.
Presents as a swelling in the groin below and lateral to the pubic tubercle
femoral hernia strangulates frequently

Treatment of a femoral hernia.


A truss is contraindicated , only open surgery.
There are many approaches
-- the low operation below the inguinal ligament via a groin-crease incision,
-- the high operation vertical incision to deal with both femoral& inguinal hernias

Paraumbilical and umbilical hernias

It is a protrusion through the linea alba just above or sometimes just below the
umbilicus or through the umbilicus .
It is rounded or oval in shape.
It can become very large.
The neck is often narrow.

Clinical features
Women are affected 5 times more frequently than men.
Large hernia causes dragging pain by its weight.

5
Treatment
6
Operation is advised in all cses. Except in children below 5 years .
hernioplasty; in very large hernias(fascial defect>4cm) or for recurrent hernias.

Epigastric hernia(fatty hernia of the linea alba)

It occurs through the linea alba(midline) between the xiphoid process and the
umbilicus, usually midway between them.
Consisting of extraperitoneal fat through the linea alba.
More than one hernia may be present.

Clinical features
local pain(varying from mild to sever penetrating epigatric pain),
worse on physical exersion, and tenderness to touch.

Referred pain; pain suggestive of a peptic ulcer

7
Treatment
Surgical repair is essential as there is a high risk that they will incarcerate or
strangulate.
the small opening in the linea alba is closed with non-absorbable sutures in adults and
with absorbable sutures in children.
If the hernia is large(defect greater than 4 cm), the repair should be reinforced by
mesh.

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