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  1. 1. Hernia Dr. Rekha Pathak, Senior scientist, IVRI • Def: • Protrusion of body cavity contents • Into normal / Abnormal opening in the wall of that cavity • To lie beneath the intact skin or to occupy another body cavity
  2. 2. Constituent of hernia Ring, Sac and Contents• H. Ring:• Rupture of abdominal wall- Ventral hernia• Diaphragm is the limiting wall: DH• Normal opening/ Passage: Inguinal ring / canal
  3. 3. Sac• In external hernia-• Skin• M.fibres• Fibrous tissue• Parietal peritoneum
  4. 4. Contents• Intestine• Omentum• Liver• Spleen• Bladder• uterus
  5. 5. Classification of hernia• 1. OCCURRENCE• Congenital• Aquired• 2. LOCATION:External : has ring , sac and contentsEg: ventral, lateral , inguinal (bubonocele), scrotal umblical(exomphalos, omphalocele) , perineal
  6. 6. Internal: no sacEG. DH, gut- tie (occasional)Interstitial : between the abdominal muscles
  7. 7. Classification of hernia• 3. According to contents• Enterocele• Epiplocele• Enteroepiplocele• Gastrocele• Reticulocele• Vesicocele• Hysterocele
  8. 8. Classification of hernia• 4. Depending on cause:• Traumatic H.• Infectious H.
  9. 9. • 5.Based on functional alteration• Reducible- contents returned through ring into original position• Irreducible – adhesions(sac and contents)• Incarcerated- voluminous contents due to venous congestion• Strangulated- necrosis and extensive adhesions
  10. 10. Diagnosis• Symptoms:• 1. Physical :• Swelling – variable in size• (abscess, hematoma , cyst, neoplasm )- aseptic exploration
  11. 11. • Palpation of ring• Consistency of sac: enterocele(elastic), epiplocele (doughy)
  12. 12. Diagnosis• Functional symptom• Absent in reducible and non- complicated hernia• Colic in incarcerated hernia• Severe pain, temp.etc
  13. 13. Radiography
  14. 14. Complications of hernia• Adhesions• Hydrocele of sac• Incarceration-absorption of water in enterocele- making reduction difficult• Torsion• Strangulation-called as acute hernia
  15. 15. Umblical hernia• Common in dogs and bovine calves• Rare in lambs & kids• No gender predisposition, among ruminants- common in females
  16. 16. • Congenital/ aquired• Congenial – hypoplastic rectus muscles and aponeurosis of oblique muscle(wide thin linea alba from xiphoid to pubis )- DH
  17. 17. • Aquired: cord cut close to abdomen• Bitch chews• Rough handling• Excessive straining(diarhoea/ constipation)
  18. 18. • Infection of cord• Congenital/ aquired – primarily hereditary – size- H.ring- recessive genes(2 or more)
  19. 19. Clinical signs• Swelling• Ring• Contents – omentum / fat/ intestinal loop• More voluminous content/ adhesions- ring not felt- RG diagnosis
  20. 20. Treatment• Conservative: belly bandages/ wooden or metal clamps• Reducible- small content• Dorsal recumbency- reduce manually the contents- clamp the empty sac- jaw of clamp and tighten the nuts
  21. 21. • Aim : to obliterate hernial sac – stimulate healing of the ring• Sac – necrosis- sloughs down – 10- 12 days• Skin wound- heals by 2nd intention• Inject irritants – HCL/ H2so4- around ring- stimulate fibrous tissue formation
  22. 22. Radical surgery• 12-24 hrs fasting• Local infiltration/GA• Dorsal recumbency
  23. 23. • Midline/ extended past craniocaudal limits on the ring
  24. 24. • In large hernia- elliptical incision – removal of isolated skin
  25. 25. • Open the sac• More content and small ring- go for kelotomy
  26. 26. • Reducible – invert the contents• if large and adhesions: remove
  27. 27. 1. Bet. Sac(inner wall) and contents2. Bet. Sac with skin/muscles Edge of ring – debrided If sac is big- remove the sac
  28. 28. • Series of simple interrupted / horizontal mattress• Chromic catgut/ silk / monofilament/ steel/ nylon• Overlapping mattress- non – absorbable- tighten from centre to periphery
  29. 29. • Wide wall disruption- tension on apposition of edges• To relieve- external laminae of rectus sheath- incised on each side of incision – relieve tensionand achieve apposition of sutured H. ring• Alternatively, Hernioplasty
  30. 30. Hernioplasty (Hernial Prosthesis)• Large h. ring• Weak spot(scar) present• Large loss of tissue on edges• Allow approximation without tension• Bridge the gap• Avoid reccurrence of hernia
  31. 31. Living (fresh and preserved)• Skin- full thickness, autologous whole skin graft (DH)• Duramatter• Muscle• Fascia lata- lumbar area- no tissue reaction
  32. 32. Non – living• Metallic : stainless steel• Synthetic: Nylon, teflon, Marseli ne, Marlex, dacron, et c• Mesh/sheets
  33. 33. • Mesh – prefferred1. More flexibility2. Permits infiltrative fibrosis- scaffold – ingrowth- fibrous CT3. Minimal tissue reaction and adequate strength4. 15x30 cm
  34. 34. Techique• Remove sharp ends and corner• Close muscle defect• Edge of mesh – sutured- surrounding fascia with non- absorbable material in a horizontal mattress pattern• Close the skin