Hernia

DEFINITION

• ABNORMAL protrusion of an organ/tissue through a DEFECT in its surrounding walls

ANATOMY

• The surrounding walls of the peritoneal cavity include:
• The diaphragm
• The anterior abdominal wall musculature
• The posterior abdominal wall musculature
• The pelvic diaphragm
• Most of these surrounding muscles have parietal peritoneum as an inner lining

• COVERING
• SAC-
• Neck
• Body
• Fundus
• CONTENT
• Small/large bowel
• Omentum
• Fluid

• Congenital
• Raised intra-abdominal pressure
• Chronic cough
• Obstructive uropathy
• Constipation

EXTERNAL

• Protrudes through all layers of the abdominal wall
• Defect could be congenital or spontaneous/acquired
• Visible protrusion on inspection
• Cough impulse is positive
• Can be reduced into the peritoneal cavity when uncomplicated
• Groin / Ventral

INTERNAL

• Protrudes through an abnormal defect inside the peritoneal cavity
• Defect may be congenital or acquired (post-op, post-inflammatory)
• Not visible
• Presents with intestinal obstruction

Presentation of External Hernia

• Reducible
• Content easily returns into the peritoneal cavity
• Complicated
• Irreducible
• Obstructed
• Strangulated

Groin Hernia

Inguinal Hernia

• Congenital or spontaneous/acquired
• Congenital - incomplete obliteration of processus vaginalis
• Protrudes through the inguinal canal
• Located above and medial to the pubic tubercle
• Direct/Indirect
• Descends into the scrotum
• More common in males

Femoral Hernia

• Acquired
• Protrudes through the femoral canal
• More common in females
• Protrusion is below and lateral to the pubic tubercle
• Incidence of strangulation is high

Ventral Hernia

• Through the layers of anterior abdominal wall
• Spontaneous/Incisional
• Spontaneous - epigastric, umbilical, hypogastric
• Incisional - Post-operative

Rare Hernia

• Sliding
• Lumbar
• Interparietal
• Obturator
• Sphingelian
• Richters

• Mass/Protrusion at the site
• Positive visible and palpable cough impulse
• Reducible except complicated
• Groin Hernia
• Cannot get above groin mass
• Testicle palpable separate from inguinal hernia mass in scrotum

• Basic
• PCV
• Urinalysis
• Genotype
• Others
• Ultrasonography
• Plain X-ray
• CT

• Inguinal
• Modified Bassini
• Shouldice
• McVay
• Laparoscopic
• Femoral
• Lockwood
• Lothesian
• Laparoscopic
• Prosthetic/Mesh Repair
• Open
• Laparoscopic

• Irreducibility
• Obstruction
• Strangulation
• Recurrence