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Hernia
Lecture
S. Mutale
Introduction
• Definition
A protrusion of a viscus or part thereof
through a weakness in the abdominal wall
Classification
• Internal
• External hernia
Internal Hernia
• Hiatus
- Sliding
- Rolling
Internal hernia
• Para duodenal
• Para caecal (Retrocaecal)
• Mesenteric
• Spingelian
External Hernia
• Anatomical location
- Umbilical
- Paraumbilical
- Epigastric
- Groin (Inguinal, Femoral)
- Lumbar
- Obturator
- Incisional
Groin Hernia
• Most common hernias world wide
• Inguinal hernias are more common than
femoral hernias
• Femoral hernias are more common in
women than in men
• In women inguinal hernias are more
common than femoral hernias
Inguinal hernia
• Inguinal canal
- oblique, Inferomedial
- Contents: spermatic code, round ligament with
ileo-inguinal nerve
- Anterior wall formed by external oblique fibre re-
inforced by internal oblique
- Posterior wall formed by transversalis fascia
- Medially by the conjoint tendon
- Superficial and deep ring
Inguinal hernia
• 75% are inguinal
• Direct or indirect
• Direct inguinal hernia passes through the
triangle of Hesselbach
• Inguinal hernias occur more on the right
than on the left
• Most common elective operation world
wide is herniorrhaphy
Causes
• Congenital
- Failure of closure of processus vaginalis
- Seen in premuture babies and those with
low birth weights
Acquired
• Chronic cough
• Constipation
• Lower urinary tract obstruction
• Subacute obstruction
Inguinal hernia
.
Life history
• Reducible
• Irreducible
• Obstructed
• Strangulated
• Gangrenous
• Perforation
• Peritonitis/Fistula
Management
• History
• Examination
• Investigation
• Surgery
Herniorrhaphy
• Herniotomy (to be discussed under
paediatric surgical conditions)
complication
• Bleeding
• Haematoma
• Infection
• Injury to the vas
• Orchitis
Operation
• Sutures removed after a week
- End -

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