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Hernia

Hernias are abnormal protrusions of an organ or tissue through a weak area of muscle or surrounding wall. There are several types of hernias classified by their location such as inguinal, femoral, umbilical, etc. Inguinal hernias are further divided into direct and indirect. Indirect hernias protrude through the internal ring and superficial inguinal ring while direct hernias protrude through the Hesselbach's triangle. Herniology is a surgical subspecialty dedicated to treating hernias. Treatment methods have evolved from early cauterization and truss use to modern open and laparoscopic surgical repair techniques which aim to reinforce the weak area with surgical mesh.

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256 views36 pages

Hernia

Hernias are abnormal protrusions of an organ or tissue through a weak area of muscle or surrounding wall. There are several types of hernias classified by their location such as inguinal, femoral, umbilical, etc. Inguinal hernias are further divided into direct and indirect. Indirect hernias protrude through the internal ring and superficial inguinal ring while direct hernias protrude through the Hesselbach's triangle. Herniology is a surgical subspecialty dedicated to treating hernias. Treatment methods have evolved from early cauterization and truss use to modern open and laparoscopic surgical repair techniques which aim to reinforce the weak area with surgical mesh.

Uploaded by

shankarrao3
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Abnormal protrusion of part or whole of the viscus through a normal or abnormal opening in the wall of the cavity containing it

Groin:
Inguinal
Direct Indirect Combined

Anterior

Femoral

Pelvic

Umbilical Epigastric Spigelian


Obturator Sciatic Perineal Lumbar
Superior triangle Inferior triangle

Posterior

Abnormal protrusion of the abdominal viscus(sac) through weak area of inguinal region Classified
Anatomical site: Direct Indirect Reducibility: Reducible irreducible

Indirect protrusion of the sac through the internal ring and superficial inguinal ring Direct protrusion of the sac through the hasselbacks triangle More common in men Indirect hernia more common right side

Anatomy:
Inguinal ligament pouparts ligament Inguinal canal Contents: cord structures, illioinguinal nerve External, internal, transverse abdominis, &

cremastric muscle Hesselbachs triangle Inferior epigastric artery branch of external illiac artery

Herniology, sub specialty Dedicated clinics Own society Own journal

Congenital Fascial, Muscular Biochemical deficiency of hydroxyproline and collagen Smoking emphysema Aging elevated protease antiprotease ratio Genetic abnormal collagen gene expression Type III Vs Type I alpha 1 antitrypsin deficiency.

Space of Retzius

Space of Bogros

Type 1 indirect hernia ,normal internal ring Type 2 dilated ring, posterior wall intact Type 3 posterior wall defects Type 4 recurrent

15th century - Castration with wound cauterization or hernia sac debridement Recommended a truss

Open tissue anterior Open prosthetic ant

Bassini ,Shouldice,

Lichtenstein Rutkow-Plug Gilbert

Open posterior(pros) Laparoscopic repair(pros)

Stoppa,Nyhus, TAPP,TEP

Local Regional spinal (PDPH) Epidural General (PONV)

No single ideal operation for the permanent cure of hernia

So far no single ideal prosthesis is universally accepted


An understanding of underlying structures, anatomy, principles of the chosen technique & rationale for mesh placement is the key

CHEMICALLY INERT NOT ALLERGIC NO INFLAMMATORY REACTION IS PLIABLE NOT CARCINOGENIC

Will not attempt within 6months to allow full healing and tissue strength.

Missed secondary hernia

Inadequate fixation
Inappropriate placement

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