Dr. Sajad Ali (MBBS., MS.)Gastrointestinal & Laparoscopic

surgeon)Dr Ahmed Abanamy Hospital

What is a hernia

Hernia is derived from the Latin for "rupture"

It is the protrusion of an organ or part of an organ through a defecte in the wall of the cavity normally containing it.

Hernia is classified into three types:

* Reducible, Hernias can be reducible if the hernia can be easily manipulated back into place. * Irreducible or incarcerated, this cannot usually be reduced manually because adhesions form in the hernia sac.

* Strangulated, if part of the herniated intestine becomes twisted or edematous and causing serious complications, possibly resulting in intestinal obstruction and necrosis.

Types of herniaInguinal Indirect or indirectInguinal hernias can be direct which is herniation

through an area of muscle weakness, in the inguinal canal,

and inguinal hernias indirect herniation through the inguinal ring. Indirect hernias, the more common form, can develop at any age but are especially prevalent in infants younger than age 1. This form is three times more common in males.

Femoral Herniation through the femoral canal

Types of herniaIncisional Herniation through an area weakened by a scarUmbilicalParaumbilical Acquired defect above or below the

umbilicusEpigastric in the midline of abdomen above the

umbilicus caused by a defect in linea alba.

Groin Hernias

Incidence: - Groin hernias are found in 5% of male

population. - Represents 86% of all hernia cases. - It occurs 5 times more often in males than

females. - Inguinal 96% ( indirect 75%, direct 25%). - Bilateral in 20% of cases - Right sided hernias are more frequent than

left sided ones - Femoral 4%.

Direct Inguinal Hernia

Incidence: 25% of hernia cases The hernia contents enter the inguinal canal.These hernias are generally considered to be

acquired, and may be associated with heavy lifting, straining due to constipation, coughing, or prostatic enlargement.

Bilateral Hernia

Definition: Simultaneous Right and Left Inguinal Hernia

Common in children and elderly men If a left inguinal hernia is present, there is a

25% risk of an occult right inguinal hernia

Symptoms

A. Often asymptomatic (especially in direct hernias)

B. Pain or dull sensation in groin

Complications

A. Bowel incarcération ( acute, chronic ): The trapping of abdominal contents within the Hernia itself

B. Strangulation: pressure on the hernial contents may compromise blood supply (especially veins, with their low pressure, are sensitive, and venous congestion often results) and cause ischemia, and later necrosis and gangrene, which may become fatal.

C. Small Bowel Obstruction

FEMORAL HERNIA

I. Epidemiology A. Accounts for 4% of Groin Hernias (96% are

inguinal) B. More common in elderly women C. Gender predisposition: Female by 3 to 1 ratio 1. Femoral seen less than Inguinal Hernia even in

womenII. Pathophysiology A. Associated with increased intraabdominal pressure B. Hernia sac bulges into femoral canal . Femoral canal lies immediately medial to femoral

vein

INCISIONAL HERNIAI. Pathophysiology A. Type of Ventral Hernia B. Develops in scar of prior laparotomy or drain

site C. Risks for postoperative hernia development 1. Vertical scar more commonly affected than

horizontal 2. Wound infection 3. Wound dehiscence 4. Malnutrition 5. Obesity 6. Tobacco abuse

Treatment Options

All hernias should be surgically corrected to remove the risk of incarceration and strangulation.

If there are compelling co-morbid medical conditions that preclude surgery, then a truss, or support hernia belt may be employed. A truss does not repair the hernia defect, but will afford some relief of symptoms.

Modern methods of repair include open primary closure of the defect with sutures (Shouldice or "Canadian" Repair, Bassini Repair); patch closure with prosthetic materials (Polypropylene or Gortex) tension-free (Lichtenstein-type) and laparoscopic repair.