an overview of causes, clinical assessment, investigation and treatment of ventral hernia; groin, epigastric, umbilical, spigelian

1. VENTRAL AND GROIN
HERNIA
Dr Winston Makanga, M.B.Ch.B, M.MEd (Surg)
Consultant General and Laparoscopic Surgeon

2. Objectives of the lecture
• Definition
• Anatomy of the anterior abdominal wall
• Types of hernia
• Stages of hernia
• Etiology
• Pathology
• Clinical presentation
• Treatment

3. Definition
• A protrusion of part or whole of an organ through a weakness on the
wall of the cavity containing it
• Most herniae are abdominal

4. Anatomy of abdominal wall

5. Types
• Ventral
• Epigastric
• Umbilical and paraumbilical
• Spigelian, Lumbar
• Incisional
• Groin
• Inguinal
• Femoral
• Others
• Internal, parastomal, obturator
• Hiatal, diaphragmatic
• Extra-abdominal sites (pontine, intervertebral)

6. Hernia Progression
• Reducible
• Irreducible
• Incarcerated/Obstructed
• Strangulated
• Gangrenous/perforated

7. Etiology
• Chronic cough
• Constipation
• Urinary obstruction
• Pregnancy
• Ascites
• Abdominal muscular weakness (obesity, wasting)
• Others
• Heavy manual labor
• Congenital defects
• Surgery
• Age

8. Pathology
• Small herniae with wide necks pose minimal risk
• Large hernias cause pain and heaviness
• Interference with ADL
• Risk of incarceration leading to:
• Intestinal obstruction
• Gut ischemia
• Perforation and peritonitis

9. Clinical presentation
• Reducible mass on lying flat, appears on coughing…. ?dull pain
• Severe pain, vomiting, abdominal distension indicate a complication
• Examine for:
• Site
• Reducibility
• Direct vs indirect
• Complication
• Possible etiology
• Differential diagnoses

10. Inguinal hernia
• Anatomy of inguinal canal
• Direct vs indirect
• Clinical examination
Femoral Hernia
• Anatomy of femoral canal
• Differentiate it from inguinal hernia

11. Treatment
• Tissue repairs
• Mayo, Bassini, Shouldice
• Mesh repairs
• Open
• Laparoscopic

12. Review
• Definition
• Anatomy of the anterior abdominal wall
• Types and progression of hernia
• Etiology
• Pathology
• Presentation
• Treatment

13. Thank you