Hernia & Types

1. HERNIA

2. Definition
*A hernia is defined as the protrusion of part or
whole of an organ or tissue through the wall of
the cavity that normally contains it.
*There are numerous types of abdominal
hernia, the most common of which are hiatus,
inguinal, femoral, and incisional hernia.

4. TYPES
● Inguinal Hernia
● Femoral Hernia
● Umbilical hernia
● Incisional hernia or ventral
hernia
● Hiatal hernia

5. Inguinal Hernia
●An inguinal hernia occurs when
abdominal cavity contents enter into the
inguinal canal.
●They are the most common type of
hernia and account for around 75% of all
anterior abdominal wall hernias.

6. Classification- Inguinal Hernia
● Direct inguinal hernia (20%) – Bowel enters
the inguinal canal “directly” through a weakness
in the posterior wall of the canal, termed
Hesselbach’s triangle.
They occur more commonly in older patients.
● Indirect inguinal hernia (80%) – Bowel enters
the inguinal canal via the deep inguinal ring.

7. Risk Factors
The main factors that increase the risk of
developing an inguinal hernia:
● Male
● Increasing age
● Raised intra-abdominal pressure
● Chronic cough, heavy lifting,
● chronic constipation
● Obesity

8. Clinical Features
● common presenting symptom is a lump in
the groin, which (for reducible hernia) will
initially disappear with minimal pressure
or when the patient lies down.
● If the hernia becomes incarcerated, it can
become painful, tender, and
erythematous

9. Femoral Hernia
● Femoral hernia occur when abdominal
viscera or omentum passes through the
femoral ring and into the potential space of
the femoral canal.
● more common in women than men (ratio
3:1), because of the wider anatomy of the
female bony pelvis.

10. Risk Factors
The main risk factors for developing a femoral
hernia include:
* Female
* Pregnancy (higher incidence in multiparous
women)
* Raised intra-abdominal pressure (e.g. heavy
lifting, chronic constipation)
* Increasing age

11. Clinical manifestations
● Small and moderate-sized hernias don’t usually
cause any symptoms.
● bulge near the groin or thigh.
● Femoral hernias are often located very close to
the hip bone and as a result may cause hip
pain.
● Severe symptoms of a femoral hernia include:
- severe stomach pain
-sudden groin pain
- nausea and vomiting

12. Umbilical hernia
An umbilical hernia is a bulge through the
abdominal wall near umbilicus (belly
button). The hernia may contain tissue
from the abdomen, part of an organ (such
as the intestine), or fluid.

14. Risk factors
● Being overweight
● Age older than 60
● Fluid in abdomen (ascites)
● A large growth in abdomen
● Pregnancy, especially more than 1 pregnancy
● Chronic constipation or straining to have bowel
movements
● Repeated coughing caused by lung disease such
as COPD

15. Clinical Features
● A bulge or swelling in or near belly button
● A bulge that gets bigger when cough,
strain to have a bowel movement, or sit
up
● Umbilical hernias usually do not cause
any pain.

16. Incisional hernia
An incisional hernia is a protrusion of
tissue that forms at the site of a healing
surgical scar.

17. Pathophysiology
●The layers of the anterior abdominal wall are
normally strong, and act to maintain the integrity of
the abdominal cavity. However, once these layers
are interrupted by a surgical incision, their
continuity is disrupted and they are structurally
weakened.
●In the presence of increased intra-abdominal
pressure and/or certain risk factors (such as
smoking, infection or emergency surgery), the
contents of the abdomen are able to herniate
through the weakness, forming an incisional hernia.

18. Risk Factors
● BMI >25
● Midline incision
● Wound infection
● Advancing age
● Pregnancy

19. Clinical Features
● non-pulsatile, reducible, soft and non-tender
swelling at or near the site of a previous
surgical wound.
● If the hernia is incarcerated, it can become
painful, tender, and erythematous.
● In cases of bowel obstruction, the patient may
also present with symptoms of abdominal
distention, vomiting, and/or absolute
constipation.

20. Diagnostic measures
● Physical Examination
● X ray
● USG
● CT scan
● MRI

21. Management of Hernia
Surgical management
●Herniotomy (removal of the hernial sac only)
●Herniorrhaphy (tissue repair) : It involves a
surgeon making a long incision directly over
the hernia then tissues or a displaced organ
are returned to their original location, and the
hernia sac is removed.

22. Cont...
● Hernioplasty (mesh repair) : In
hernioplasty, instead of stitching the
muscle opening shut, the surgeon covers it
with a flat, sterile mesh, usually made of
flexible plastics, such as polypropylene, or
animal tissue.

23. Cont...
●Other surgical management includes , same as
other Abdominal surgeries.