Femoral hernias occur when abdominal contents protrude through the femoral ring into the femoral canal. They are more common in elderly women and often present without a visible lump. Half of patients are unaware of the hernia prior to strangulation. Treatment involves surgical repair via open or laparoscopic surgery to reduce hernia contents and reinforce the femoral ring with sutures or mesh. Complications are higher if the hernia is incarcerated or strangulated at time of emergency surgery. With elective repair, prognosis is generally good with low recurrence rates.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
Femoral hernia is the third common hernia after inguinal and incisional hernias. The swelling in femoral hernia is below and lateral to pubic tubercle. It is more common in females. Strangulation is very common in this hernia.
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
Femoral hernia is the third common hernia after inguinal and incisional hernias. The swelling in femoral hernia is below and lateral to pubic tubercle. It is more common in females. Strangulation is very common in this hernia.
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
This is a case study done by me as a part of my in-service education progamme in my institution...hope this may help all nurses who wants to do a case study.
Ureteric injury in Gyenec Surgery, Serious complication of gynecologic surgery
Significant morbidity and long-term sequelae
Uncommon in benign gynecologic surgery
Vaginal hysterectomy has the lowest rate of ureteral injury
Laparoscopic hysterectomy has the highestThe ureters are the muscular ,thick walled narrow tubes(Right and Left)
Each measures 25-30 cm in length and extends from renal pelvis to its entry in the bladder.The ureter are located retroperitonealy and run from the renal pelvic to urinary bladder.
First part –Enter the pelvis by crossing the common iliac vessel from lateral to medial aspect at their bifurcation just medial to ovarian vessel and run downwards along with greater sciatic notch & reaches ischial spine.
Supracondylar humerus fracture & complication for MBBS studentsYash Oza
Fracture classification, xray, complication, reduction method, surgery, cast, vascular injury, nerve injury, all the Undergraduate students should know is included
2. Femoral Hernia
A femoral hernia is the protrusion of a viscus
from the abdominal or pelvic cavity, through
the femoral ring into the femoral canal.
The (peritoneal) hernia sac may contain pre-
peritoneal fat, omentum, small bowel, or
other structures.
4. incidence
• uncommon
• F>M
• more common in parous
• > 65 years
• 3% of all hernias
• 7% of groin hernia
• nearly 5000 / year in UK
5. presenting symptoms
• Only 50% of patients are aware of
the hernia before strangulation.
• Around 60% present in the
emergency situation
• 49% were emergency repairs and
48% waiting list repairs.
non-acutenon-acute acute - emergencyacute - emergency
7. presenting symptoms
non-acutenon-acute
• pain or discomfort in groin
• groin lump
• mild pain exacerbated by bending or
lifting
• small lump (may be no lump)
• mild tenderness
• usually not reducible
10. difficulties with diagnosis
• 1/3of patients do not complain of
symptoms directly attributable to a
hernia
• a groin lump is not always present.
• obese
• elderly - other diagnoses
13. differential diagnosis
inguinal herniainguinal hernia
ABOVE and MEDIALABOVE and MEDIAL
to pubic tubercleto pubic tubercle
femoral herniafemoral hernia
BELOW and LATERALBELOW and LATERAL
to pubic tubercleto pubic tubercle
pubic tuberclepubic tubercle
femoral –v- inguinalfemoral –v- inguinal
herniahernia
14. FEMORAL INGUINAL
Sex Female male
Age Elderly > 65 years Younger - all ages
children rare common
Males 1 20
Females 1 5
Cough impulse Often absent Usually present
Reducibility Usually not Often is
Shape Globular Pear shaped
Elective Presentation (of
groin hernia) in Male
1%
Elective Presentation (of
groin hernia) in Female
20%
Present persistent intermittent
Strangulation @ 3 mths 22% 3%
Strangulation @21 mths 45% 4.5%
15. investigations
• clinical examination
–experienced clinician can usually distinguish
between Femoral and Inguinal hernia
• always examine the groin in patients
–with intestinal obstruction
–with abdominal pain
17. treatment
• Surgical Repair
• Open Surgery or Laparoscopic Surgery
• General Anaesthetic
• Local Anaesthetic and/or Regional Anaesthetic
18. treatment
• Surgical Repair
– Dissection of the sac
– Inspection / reduction of the contents
– Ligation of the sac
– Closure of Femoral Ring
• Approximation of the inguinal and pectineal ligaments
• Mesh patch
19. Surgical Repair
• Open Surgery
• Classically 3 approaches:-
– Lockwood’s infra-inguinal approach
– Lotheissen‘s trans-inguinal approach
– McEvedy’s high approach
– ischaemic bowel – high approach
20. treatment
• Surgical Repair
• Open Surgery or Laparoscopic Surgery
– bladder may be involved in medial part of hernia
sac
– Repair suturing the inguinal ligament to the
pectineal ligament non-absorbable sutures
– avoid any pressure on the femoral vein
21. treatment
Local Anaesthetic
• The iliohypogastric and ilioinguinal nerves (T12 and
L1) supply the lower abdomen. They are blocked by
an injection of local anaesthetic between internal
and external oblique muscles just medial to the
anterior superior iliac spine.
• The genitofemoral nerve (L1,2) supplies inguinal cord
structures and the anterior scrotum via its genital
branch and supplies the skin and subcutaneous
tissues of the femoral triangle via the femoral
branch.
22. treatment
LA or Regional Anaesthetic -Advantages
• With a careful technique, local anaesthesia causes
minimal physiological disturbance
• patients with cardiovascular or respiratory disease
• The absence of postoperative sedation or drowsiness
allows early ambulation and diminishes the
requirement for recovery facilities.
• provides postoperative analgesia for up to four hours
• When adrenaline is mixed with the local anaesthetic
(normally in a dilution of 1:200,000) useful
vasoconstriction is produced resulting in a relatively
bloodless field.
23. treatment
LA or Regional Anaesthetic –Disadvantages
• must be carried out gently.
• Although pain sensation is usually blocked by the
anaesthetic, traction on certain tissues, particularly
the peritoneum, is uncomfortable.
• Larger hernias, particularly those with incarcerated
bowel may prove unsuitable for local anaesthesia.
• Some sedation during the operation may be required
for anxious patients which loses some of the benefits
of avoiding general anaesthesia. Patients who are
excessively nervous may be unsuitable for surgery
under local anaesthesia.
24. treatment
• pre-operative consent - risks/complications
• Wound haematoma
• Wound infection
• when using ‘mesh’ antibiotics are usually given during the operation
• lymph (fluid) may collect under the wound and need to be drained off.
• Nerve damage - several nerves cross the operative field in hernia surgery.
• Some patients develop chronic pain after hernia surgery, probably due to
the pressure from the mesh on the nerves (occurs in about 2% of hernia
repairs).
• Recurrence of the hernia - fortunately recurrence after hernia repair
should be rare (1-5%).
25. treatment
presenting as an emergency
• increased morbidity and mortality
• increased rates of bowel resection
• increased complications
• wound infection
• cardiovascular and respiratory complications
• mortality X20 if bowel resection required (cf
elective repair without bowel resection)
26. prognosis
• The mortality for elective hernia repair is:
• 0.1% below the age of 60
• 0.2% between 60 and 69
• 1.6% between 70 and 79
• 3.3% over the age of 80
• The risk for emergency repair of a
strangulated hernia is 10 times higher and
many patients are 80 years or over.
The overall operative mortality for
strangulated hernia is 10%: