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HERNIA

Dr. Pirma Hutauruk Sp(K)Trauma,ICS

SMF Bedah RS D H. A!du" Mu"uk Ba#dar $ampu#%

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TYPES OF HERNIAS OF ABDOMINALWALL

ININA$ ABD/MINA$ +A$$ I#diret i#%ui#a", Diret i#%ui#a",

Fem&ra" ANTERI/R ABD/MINA$ +A$$

m!i"ia", Epi%a'tri, Spi%e"ia#,Supra0e'ia"

PE$1IC

/!turat&r, Siati, Peri#ea" $MBAR

Superi&r "um!ar tria#%"e (r2#e"t) I#eri&r "um!ar tria#%"e (Petit)

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ANATOMY OF ABDOMINAL WALL :

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INGUINAL ANATOMY

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INGUINAL HERNIA :

Incidence Not known

Westen co!nties : "#$"%&' M()e : *e+()e, "-:"

Pe(k incidence : in*(nt ' (d!)t : .# $ /#0e(s o)d

Lic1tenstein "223: 4##### o5e(tions60e(

in USA

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ETIOLOGY

C%e#ita" &r A3uired Three imp&rta#t at&r'

E4i'ti#% 5pre&rmed 'a6 Repetiti & i#rea'ed

i#traa!d&mi#a" pre''ure'

+eak#e'' & mu'"e 7apeur&ti ti''ue' 8 time (a%e)

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TYPES OF INGUINAL HERNIA :

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7LINI7AL MANIFESTATIONS :

Predi'p&'iti &upati*ei%ht "iti#%

$&a" '2mpt&m' redui!"e - irredui!"e "ump %r&i# di'&m&rt, pai#

S2'temi '2mpt&m' Cardi#a" 'i%#'& &!'truti C&"ik2 a!d&mi#a" pai#,

0&miti#%, a!d&mi#a" di'te#ti,a#d 'ti ati.

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7LINI7AL GRADING

G(de Red!ction 5(in O8st!ction to9ic

e5oni8)e $ $ $ ie5oni8)e $ $ $ $

inc(ce(tion $ co)ic $

st(n;!)(tion $ ste(d0 ince(se)e!coc0tosis

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PHYSI7AL Eso)id' ;(s' )i?!id@ 71(n;es wit1 co!;1

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DIFFERENTIAL DIAGNOSIS

Fem&ra" her#ia 1a%i#a" h2dr&e"e

H2dr&e"e & &rd : a#a" & Nuk #de'e#ded te'ti' $ip&ma & the &rd

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TREATMENT

Indic(tion o* S!;e0

A)) ;oin6in;!in() 1eni(s

Mini+() o5e(tie isks >#@

Risk o* !nte(ted 1eni( :St(n;!)(tion wit1 (ttend(nt isks

conco+it(nt +edic() 5o8)e+s do not5ec)!de t1e need o* !nde;oin; s!;e0

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TREATMENT :

"%## B7 Fist e5oted c(seo* ;oin 1eni(

4## AD P(!) *o+ Ae;in( Heni() s(c )i;(tion E9cision o* 1eni() s(c

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TREATMENT :

"CC. Edo(do B(ssini >It()0@

F(t1e o* Moden Henio1(510

Dissection (nd econst!ction o* t1ein;!in() c(n()

S5)ittin; o* o8)i?!s e9ten!s(5one!osis

Dissection 1i;1 )i;(tion o* 1eni()s(cc

S!t!in; t1e o8) int +' t(nsF(sci(' to in !in() )i (+ent

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EDUARDO BASSINI HERNIORHHAPY

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7HESTER B M7AY' MD' PHD"2.# >7OOPERS LIGAMENT REPAIR@

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S EE SHOULDI7E' "2.%

+!)ti)(0e e5(i

ec!ence (te J "&

co+5)ic(ted

e9tensie dissection

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TENSION FREE , MESH GRAFT

"2C4 : Gi)8et

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GER "22#' ELEK UND LEIN "22#LAPAROS7OPI7 INGUINAL HERNIA REPAIR

T(ns5eitone() 6 5e5eitone()

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FEMORAL HERNIA :

I#ide#e Fema"e Ma"e ;

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UMBILI7AL HERNIA

Pot!sion o* (8do+in() contentt1o!;1 t1e !+8i)ic() in; into t1e(8do+in() w())

7on;enit() de*ect - c+ :

Re;ession >$@

O*ten inc(ce(ted T16 : est oe 5(n'

+es1 ;(*t

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EPIGASTRI7 HERNIA :

Pr&tru'i &

a!d&mi#a"te#tthr&u%h adeet i# the"i#ea a"!a.

Ma2 mimipepti u"er

Th:rep&'iti

the 'a, "&'ethe

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ENTRAL HERNIA

I#i'ia"her#ia p&'t

&perati0e Predi'p&'ti

*&u#di#eti

au"t2teh#i3ue

*&u#d

dehi'e#e

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SPIGELIAN HERNIA :

Heni( (t )ine(se+i)!n(is S5i;e)i

D6: USG

T16 Henioto+0(nd c)ose t1ede*ect

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LUMBAR HERNIA :

Heni( : Gin*e)t Petit

T1 : Henioto+0

Henio5)(st0

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PELI7 HERNIA

O8t!(to 1eni(': Hows1i5 Ro+8e;

si;n DRE : 1eni() )!+5

Sci(tic 1eni( T16: o5e(tie

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PERINEAL HERNIA

5ot!sion o* tiss!est1o!;1 t1e +!sc)es

(nd *(sci(e o* t1e5e)ic di(51(;+

Anteio 1eni(:)(8i()' 5!dend()' o

(;ino)(8i() Posteio 1eni( T1:t(ns(8do+in()

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OTHER HERNIAS :

Litte Heni(' Scot() 1eni(

Inten() Heni( : 5((d!oden()

+esenteic Fo(+en o* Wins)ow Heni(s

Di(51(;+(tic 1eni(

TERIMA ASIH

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TERIMA ASIH