This document provides information on hernias, including their epidemiology, anatomy, classification, and management. It discusses that 75% of abdominal wall hernias are found in the groin, with 95% being inguinal hernias. Inguinal hernias are 9 times more common in males than females. Examination of inguinal and scrotal masses involves inspection for bulging and palpation to characterize lumps. Management options are also covered.

1. BY: GKG
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2. OUTLINE
 Introduction
 Epidemiology of hernia
 Anatomy of the inguinal region
 Hernia classification and risk factors
 Management
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3. INTRODUCTION
 Hernia is defined as an area of weakness or
complete disruption of the fibro muscular tissues
of the body wall
 Structures arising from the cavity contained by the
body wall can pass through, or herniate, through
such a defect
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4. EPIDEMOLOGY
 75% of abdominal wall hernia are found in the
groin
 95% of all groin hernia are inguinal hernias the
remaining being femoral hernia
 Inguinal hernia ..9 times common in males
than women
 Femoral hernias are common in female, still the
most common hernia in women is inguinal hernia
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5. CONT…
 Common age ..infants <1yr and
>40yr
 800,000 operation for inguinal hernia annually
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6. ANATOMIC CLASSIFICATION
 Congenital Vs
acquired
 Indirect Vs
direct
 Femoral hernia
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7. CONT…
 Direct
hernia
s
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8. ETIOLOGY
 Congenital or Acquired diseases
 Risk factors are likely multi-factorial, the common
denominator being a weakness in the abdominal wall
musculature
 Repeated increases in intraabdominal
pressure
 Pregnancy
 Chronic Obstructive Pulmonary Disease,
 Ascites
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9. CONT…
 Smoking
 Birth weight <1500 g
 Family history of a hernia
 Upright position
 Congenital connective tissue disorders
 Defective collagen synthesis
 Previous right lower quadrant incision
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10. CONT…
 Heavy lifting
 Physical exertion (?)
 presence of a PPV
 prolonged standing
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11.  Older age
 Male sex
 Caucasian race
 History of abdominal aortic aneurysm
 Abdominal wall injury
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12. CLASSIFICATION AND PATHOGENESIS
Etiologically
— congenital defect or is acquired.
 Congenital hernia — due to failure
of the processus vaginalis to close
Acquired hernia — due to a
weakening or disruption of the
fibromuscular tissues of the body wall.
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13. Anatomic location
— simplest and most useful system
1) inguinal hernias
indirect inguinal
direct inguinal hernias
2)femoral hernias.
Indirect inguinal hernia — most common in
males and females. protrude at the internal
inguinal ring.
Most indirect inguinal hernias in adults are
congenital
Direct inguinal hernia — protrude medial to
the inferior epigastric vessels within
Hesselbach's triangle
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14. Inguinal hernia
Herniation of intra abdominal contents through
inguinal canal in the groin .
INCIDENCE
 Groin Hernias= 75% of abdominal wall hernias .
◦ Indirect IH= 2/3 > Direct IH=1/3
 Occurring at any age
 M>F 20:1
◦ Incidence of inguinal hernias in males has a bimodal
distribution with peaks
 before 1 year of age and
 then again after age 40.
 The lifetime risk of developing an inguinal hernia
24%.
 Unilateral inguinal hernia RT>LT
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15. Etiology
 Inguinal hernias may be considered
◦ congenital or
◦ acquired diseases.
 the risk factors are likely multi
factorial, the common denominator
being a weakness in the abdominal
wall musculature
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16.  Congenital hernias, which make up the
majority of pediatric hernias,
◦ Failure of the peritoneum to close results in
a patent processus vaginalis (PPV)
 high incidence of indirect inguinal hernias in
preterm babies.
 It should be noted that the processus vaginalis
continues to close as the child ages, with most
closing within the first few months of life.
 Children with congenital indirect inguinal hernias
will present with a PPV;
 however, its presence does not necessarily
indicate an inguinal hernia
gkg 16
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17. Causes of Groin Herniation
Smoking – results in acquired
collagen deficiency
 Obesity - Fat acts to separate muscle
bundles & layers, weakens aponeurosis
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18. Multiparous - owing to stretching
of the pelvic ligaments
Previous right lower quadrant incision
 ilio ing n inj in appendectomy
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19. Anatomy of inguinal canal
inguinal canal is an opening in the
lower abdomen through which scrotal
contents pass.
it is 3.75 cm(4-6) long
Shaped like a cone (baseapex)
directed downwards and medially from
the deep to the superficial inguinal
ring.
19
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20.  deep inguinal ring
◦ =U-shaped opening by condensation of
the transversalis fascia 1.25 cm above
the mid point of the inguinal ligament
 superficial inguinal ring
 a triangular opening in the external
oblique aponeurosis 1.25 cm above the
pubic tubercle.
bound: med & lat=crura of eoa
inf= pubic crest
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21. *Boundaries of the inguinal canal
  anteriorly = external oblique aponeurosis
with the conjoined muscle (internal oblique
and transversus abdominus muscles) laterally.
  posteriorly the floor of the inguinal canal =
fascia transversalis and the conjoined
tendon (internal oblique and transversus
abdominus) medially.
 superiorly = arched fibers of conjoined
muscles.
 inferiorly = inguinal ligament
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22. gkg 22
Linea alba
Rectus abdominis mus
Internal oblique muscle
Anterior superior iliac spine
Aponeurotic portion of
internal oblique
Aponeurotic portion
of external oblique
(cut edge)
Inguinal ligament
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23. gkg 23
Genital branch of genitofemoral nerve
Femoral branch of genitofemoral nerve
Lateral femoral cutaneous nerve of the
thigh
Femoral and genital branch
of genitofemoral nerve
Lateral femoral cutaneous
nerve of the thigh
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24. gkg
24
Transversus abdominis
Internal oblique mus
External oblique mus
Transversalis fascia
Inferior epigastric vessels
Conjoined tendon
Cremasteric muscle
Femoral vessels
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25. * contents of inguinal canal
In male= spermatic cord, the ilio-
inguinal nerve & the genital branch of the
genitofemoral nerve. Reminants of
process vaginalis
 The spermatic cord consists of 3 aa,3vv,2nn,
pampiniform venous plexus anteriorly and the
vas deferens posteriorly, with connective tissue
and remnant of the processus vaginalis between.
 The cord is then enveloped in layers of spermatic
fascia.
In female= the round ligament
replaces the spermatic cord
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26. Defense mechanism=factors protecting
inguinal hernia
1.obliquity of inguinal canal
2.during straining & cough ,conjoined tendon
contracts
3.Increased intra abdominal pressure produce
plugging effect on ext ring ,deep ring is pulled
up & laterally by transversalis m(ball valve
effect)
gkg 26
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27. 1. Indirect (oblique) inguinal
hernia
An indirect hernia
most common in the
young, whereas a
direct hernia is most
common in the old.
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28. gkg 28
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29.  It may be due to persistent pv (CONG)
or acquired.
 Type
1. complete/scrotal =up to root of
scrotum
2.funnicular =pv patent up to roof of
scrotum
3.bubonocele =pv patent in inguinal
region/canal only
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30. Contents can be:
◦ Omentum = omentocele (synonym:
epiplocele);
◦ Intestine = enterocele; more commonly small
bowel but may be large intestine or appendix;
◦ a portion of the circumference of the intestine
= Richter’s hernia;
◦ a portion of the bladder (or a diverticulum) may
constitute part of or be the sole content of a
direct inguinal, a sliding inguinal or a femoral
hernia;
◦ ovary with or without the corresponding
fallopian tube;
◦ a Meckel’s diverticulum = Littre’s hernia;
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31. 2. Direct inguinal hernia (DIH)
In adult males, 35% of inguinal hernias are
direct.
A direct hernia comes out directly forwards
through the posterior wall of the inguinal
canal, it is due to weakness of posterior
wall
Through hesselbachs triangle
=weakness in post wall of ing canal
1.med=lat bord of rectus
abdominis
2.lat=inf epigast a
gkg 31
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32. gkg 32
Inguinal ligament
Iliopubic tract
Inferior epigastric vessels
Cremasteric muscle
Deep inguinal ring
Anterior superior iliac spine
Conjoined
tendon
Inguinal triangle, si
of direct hernia
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33.  In contrast to an indirect inguinal
hernia, a direct inguinal hernia lies
behind the spermatic cord.
 The sac is often smaller than the
hernial mass would indicate, the
protruding mass mainly consisting of
extraperitoneal fat.
 Direct hernias do not often attain a
large size or descend into the scrotum
 As the neck of the sac is wide, direct
inguinal hernias do not often
strangulate.
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34. Is always acquired
Often the patient has poor lower
abdominal musculature, as shown
by the presence of elongated
bulgings (Malgaigne’s bulges).
gkg 34
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35. gkg 35
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36. Different types of DIH
◦ Oglive h, Funicular direct inguinal hernia
(synonym: prevesical hernia)
 This is a narrow-necked hernia with prevesical fat
and a portion of the bladder that occurs through a
small oval defect in the medial part of the
conjoined tendon just above the pubic tubercle.
 elderly men and occasionally becomes
strangulated.
 operation should always be advised.
◦ Dual (synonym: saddle-bag, pantaloon)
hernia
 two sacs that straddle the inferi- or epigastric
artery
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37. c/f of inguinal hernia
Asymptomatic :diagnosed incidentally
Patients who present with a symptomatic
frequently present with
Swelling * swelling on the groin, gradually
increasing, usually reducible
groin pain.= pressure onto nerves , leading
to a range of symptoms:
• Pressure or heaviness , dragging sensation ,
Sharp pains (indicate an impinged nerve),
neurogenic pains may be referred to the scrotum,
testicle, or inner thigh.
 Less commonly, extrainguinal symptoms
such as change in bowel habits or urinary
symptoms.
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38. Examn of inguino scrotal mass
 Inspection
1. bulge in the groin = seen during standing/
coughing
 Ask to stand look for bulging, hernia pops out
 if no bulge- ask to cough or bear down
(i.e.,Valsalva's maneuver) to protrude the
hernia contents.
2. If already visible swelling
 visible cough impulsatile test
  check if it comes from above ing lig
3. MASS= shape location, uni/bilat
4. Skin= redness, edema, scar, discoloration
5. Visible peristalisis
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39.  palpation
1. Characterise the mass:
Temp,consistency,,tenderness,
measure size
 Soft & elastic= enterocele:
 Firm & doughy= omentocele
 Tense & tender= strangulated h:
 Bag of worms =varicocele
2. Expansile Cough impulse test
3. Palpate cord structures
if hernia cord cant be palpated with out
the mass
if scrotal mass cord can be palpated
separately/going above the mass
4. Check reducibility- ask to reduce
5. Internal ring oclusion test
6. Finger invagination test
7. relation with pubic tubercle
8. 3 finger test
gkg 39
To diff scrotal or
abdominoscrotal
To diff DIH/IIH/FH
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40.  Auscultate
 Examine opposite side
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41.  Intra operatively differentiating
 DIH/IIH
SITE OF DEFECT
A direct hernia comes out directly
forwards through the posterior wall of the
inguinal canal, IIH comes through internal
ring
RELATION TO INFERIOR EPIGASTRIC
VESSELS
the neck of the indirect hernia is lateral to
the inferior epigastric vessels, the direct
hernia usually emerges medial to this
except in the saddle-bag or pantaloon type,
which has both a lateral and a medial
component.
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42. RELATION TO SPERMATIC CORD
An indirect hernia sac will generally be found
on the anterolateral surface of the spermatic
cord.
Direct hernias sac will behind the spermatic
cord
IH/FH
the relation of the neck of the sac to the medial
end of the inguinal ligament and the pubic
tubercle;
i.e. in the case of an inguinal hernia the
neck is above and medial,
whereas that of a femoral hernia is below
and lateral 9/6/2022 42
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43. gkg 43
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44. Ix
 The diagnosis is ambiguous;
radiologic investigation may provide
the answer.
◦u/s
◦CT
◦MRI
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45. DDx of inguinal hernias
in the male
1. hydrocele
2. spermatocele
 Spermatoceles are cystic masses that arise from the caput
of the epididymis;
thus, they are always located superior to the testis and
are palpated distinct from the testis, thereby differentiating
them from hydroceles
 The distinction between a spermatocele and an epididymal
cyst is mainly one of size; epididymal cystic masses that are
larger than 2 cm are usually called spermatoceles.
3. femoral hernia
4. incompletely descended testis in the
inguinal canal
5. lipoma of the cord
6. varicocele
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46. DDx of inguinal hernias
in the female
1. hydrocele of the canal of Nuck
2. femoral hernia
3.funiculitis,
4.ing lymphadenitis
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47.  Malignancy
Lymphoma
◦ Retroperitoneal sarcoma
◦ Metastasis
Testicular tumor
 Primary testicular
Varicocele
◦ Epididymitis
◦ Testicular torsion
◦ Hydrocele
◦ Ectopic testicle
◦ Undescended testicle
 Femoral artery
aneurysm or
pseudoaneurysm
 Lymph node
 Sebaceous cyst
 Hidradenitis Cyst of the
canal of Nuck (female)
 Saphenous varix
Disappear on lying
 Psoas abscess is
fluctuant
 Hematoma
 Ascites
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48. Treatment of inguinal
hernia
1.open
2.Laparoscopic repairs
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49. Treatment of inguinal
hernia
1= herniotomy
excision of the hernial sac
By itself it is sufficient for the treatment of
hernia in
infants, adolescents and young adults- 14-16yrs/children
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50. 2= Herniorrhaphy=
Herniotomy and repair (herniorrhaphy)
consists of:
(1) excision of the hernial sac; plus [ I.e
herniotomy]
 (2) repair of the stretched internal inguinal ring
and the transversalis fascia; and
(3) further reinforcement of the posterior wall of
the inguinal canal.
indn=d/I h with good m tone
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51. * bassinis herniorrhaphy
Herniotomy with approximation of post
wall(suturing congoind tendon with inguinal
ligament)
*shouldice herniorrhaphy
3 step
1st lower & upper flaps of transversalis
fascia sutured 2nd conjoined tendon sutured
with inguinal lig
3rd upper flap of external oblique
aponeurosis
sutured with inguinal ligament
*McVay
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52.  3. hernioplasty=
◦ strengthening post wall of ing canal
◦ Indn=i/d h with good m tone/weak m
=recurrent h
◦ *Lichenstine repair =strengthening post wall
by proline meesh
◦ *Prolene daring =sutuiring ing lig w cong
tend in criss cross manner
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53. Femoral hernia
Definition: Protrusion of abdominal
contents through femoral canal
 F>M: It accounts for about 20% of hernias in
women and 5 % in men.
◦ NB: The most common type of groin hernia in
females is the indirect inguinal hernia.
of all hernias it is the most liable to
become strangulated because of the
narrowness of the neck of the sac and
the rigidity of the femoral ring.
gkg 53
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54. Anatomy of femoral canal
◦ *femoral canal occupies the medial
compartment of the femoral sheath
◦ ant continuation of facia transversalis
post=of facia lata
◦ The canal is shaped like a cone pointed
inferiorly,
◦ it extends from the femoral ring above to the
saphenous opening below (the fossa ovalis;
the opening of the fascia latte for the great
saphenous vein.)
◦ It is 1.25 cm long and 1.25 cm wide at its
base
◦ *contents of femoral canal= fat, lymphatic
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55.  *The femoral ring is bounded:
anteriorly by the inguinal ligament;
posteriorly by Astley Cooper’s
(iliopectineal) ligament, the pubic bone
and the fascia over the pectineus muscle;
medially by the concave knife-like edge
of Gimbernat’s (lacunar) ligament, which
is also prolonged along the iliopectineal
line, as Astley Cooper’s ligament;
laterally by a thin septum separating it
from the femoral vein-silver fascia
gkg 55
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56.  Femoral sheath contents
1.Femoral Canal
2.Vein,3.Artery,4.Nerve
gkg 56
Genital branch of genitofemoral nerve
Femoral branch of genitofemoral nerve
Lateral femoral cutaneous nerve of the
thigh
Femoral and genital branch
of genitofemoral nerve
Lateral femoral cutaneous
nerve of the thigh
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57. fig. Femoral sheath with femoral hernia
through the femoral canal
gkg 57
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58. gkg 58
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59. Causes
◦ never congenital
◦-pregnancy
◦–wide femoral canal
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60. Clinical features of femoral
hernia
*F/M 2:1
female patients are frequently elderly, male
patients are usually between 30 and 45 years
of age.
* rt side >lt
The right side is affected twice as often as the
left and in 20% of cases the condition is
bilateral.
* more prevalent in multiparous women
* less pronounced symptoms: may have
dragging pain
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61. DDX of femoral hernia
 1. inguinal hernia
◦ The neck of the sac lies above and medial to the medial
end of the inguinal ligament at its attachment to the
pubic tubercle. The neck of the sac of a femoral hernia
lies below this
 2. saphena varix=
saccular enlargement of the termination of the long
saphenous vein , usually accompanied by other signs of
varicose veins.
The swelling disappears completely when the patient
lies flat whereas a femoral hernia sac is usually still
palpable.
In both, there is an impulse on coughing.
A saphena varix will, however, impart a fluid thrill to the
examining fingers when the patient coughs or when the
saphenous vein below the varix is tapped with the
fingers of the other hand.
Sometimes a venous hum can be heard when a
stethoscope is applied over a saphena varix.
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62. 3.enlarged femoral lymph node
4. Lipoma.
5. femoral artery aneurysm
6. psoas abscess = fluctuating swelling
◦ There is often a fluctuating swelling – an iliac
abscess – which communicates with the
swelling in question. If suspected, an
examination of the spine and a radiograph will
confirm the diagnosis.
7. distended psoas bursa.
◦ The swelling diminishes when the hip is flexed
and osteoarthritis of the hip is present.
8. Rupture of the adductor longus with
haematoma formation. Suspected on
clinical history gkg 62
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63. Different types of fh
 Hydrocele of a femoral hernial sac
◦ The neck of the sac becomes plugged with omentum
or by adhesions and a hydrocele of the sac results.
 Laugier’s femoral hernia
◦ This is a hernia through a gap in the lacunar
(Gimbernat’s) ligament. The diagnosis is based on the
unusual medial position of a small femoral hernia sac.
The hernia has nearly always strangulated
 Narath’s femoral hernia
◦ This occurs only in patients with congenital dislocation
of the hip and is the result of lateral displacement of
the psoas muscle. The hernia lies hidden behind the
femoral vessels.
 Cloquet’s hernia
◦ Cloquet’s hernia is one in which the sac lies under the
fascia covering the pectineus muscle. Strangulation is
likely. The sac may coexist with the usual type of
femoral hernia sac.
gkg 63
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64. Treatment
The constant risk of strangulation is
sufficient reason to recommend
operation.
Operative treatment
◦ the low operation (Lockwood)
◦ the high operation (McEvedy)
◦ the inguinal operation (Lotheissen)
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65. COMPLICATION OF groin HERNIA
1.Irreducible
Reducible – contents can be returned to
abdomen
Irreducible – contents cannot be returned but
there are no
Irreducible hernias – there is a risk of
strangulation at any time
2.obstructed
when bowel inside the hernia gets
obstructed. bowel in the hernia has good
blood supply
Obstructed hernias – usually go on to
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66.  Incarcerated hernia
is often used loosely as an alternative
to obstruction or strangulation but is
correctly employed only when it is
considered that the lumen of that
portion of the colon occupying a
hernial sac is blocked with faeces.
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gkg

67. 3.strangulated
when blood supply to the hernial content
gets obstructed/decreased.
4.Involvement of the hernia sac in
disease process
Inflamed – contents of sac have
become inflamed
a) inflammation ,peritonitis, acute
appendicitis
b) Cancer
5.Rupture of the hernia
6.Testicular strangulation
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68. Strangulated inguinal hernia
◦ blood supply of its contents is seriously
impaired, rendering the contents ischaemic.
Gangrene may occur as early as 5–6 hours
after the onset of the first symptoms.
◦ Although inguinal hernia may be 10 times
more common than femoral hernia, a femoral
hernia is more likely to strangulate because of
the narrowness of the neck and its rigid
surrounds
gkg 68
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69. ◦ Indirect inguinal hernias strangulate more
commonly, the direct variety not so often
because of the wide neck of the sac.
◦ In order of frequency, the constricting agent
is:
 (1) the neck of the sac; (2) the external inguinal
ring in children; and (3) adhesions within the
sac (rarely).
◦ Usually the small intestine is involved in the
strangulation, with the next most frequent
being the omentum; sometimes both are
involved. It is rare for the large intestine to
become strangulated in an inguinal hernia,
even when the hernia is of the sliding variety
9/6/2022 69
gkg

70.  Clinical features
◦ Sudden pain, at first situated over the hernia, is
followed by generalised abdominal pain, colicky in
character and often located mainly at the umbilicus.
◦ Nausea and subsequently vomiting ensue.
◦ The patient may complain of an increase in hernia
size.
 On examination
◦ the hernia is tense,
◦ extremely tender and
◦ irreducible, and
◦ there is no expansile cough impulse.
 Unless the strangulation is relieved by
operation, the spasms of pain continue until
peristaltic contractions cease with the onset of
ischaemia, when paralytic ileus (often the result
of peritonitis) and septicaemia develop.
◦ Spontaneous cessation of pain must be viewed
with caution, as this may be a sign of perforation
gkg 70
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71.  Preoperative treatment of strangulated
inguinal hernias
◦ ■ Resuscitate with adequate fluids
◦ ■ Empty stomach with nasogastric tube
◦ ■ Give antibiotics to contain infection
◦ ■ Catheterise to monitor haemodynamic
state
 Do herrniorrhaphy
gkg 71
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Treatment

72. Femoral hernia — located
inferior to the inguinal ligament
and protrude through the femoral
ring, which is medial to the
femoral sheath which contains
femoral nerve, femoral artery, and
femoral vein.
least common type of hernia, 40
percent present as emergencies
with incarceration or strangulation
9/6/2022 72
gkg

73. CLINICAL MANIFESTATION
 Most are asymptomatic
 Common presenting symptom
 dull feeling of discomfort or heaviness in the groin
region that is exacerbated by straining the
abdominal musculature
 Pain…incarceration, strangulation
 Bowel obstruction, urinary compliant
 Duration, progress, reducibility
 Underlying risk factor
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gkg

74. PHYSICAL FINDINGS
 Ideally in standing position
 Incarcerated hernia
 Mild tenderness
 Strangulated
◦ Tender , warm, may have surrounding skin
erythema
◦ Fever, hypotention, leukocytosis
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gkg

75. IMAGING
Abdominal Ultrasound
CT
MRI
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gkg

76. DDX IN THE MALE
 In males the DDx includes:
• vaginal hydrocele
• encysted hydrocele of the cord
• spermatocele
• femoral hernia
• incompletely descended testis
• lipoma of the cord
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gkg

77. TYPES AND COMPLICATIONS
OF HERNIA
 Reducible – contents can be returned to abdomen
 Irreducible – contents cannot be returned but there
are no other complications
 Obstructed – bowel in the hernia has good blood
supply but bowel is obstructed
 Strangulated – blood supply of bowel is obstructed
 Inflamed – contents of sac have become inflamed
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gkg

78. TREATMENT
 The treatment of all hernias, regardless of their
location or type, is surgical repair
 Goal
◦ Alleviate symptoms to prevent complication
 Risk of incarceration of a hernia is greatest soon
after the hernia manifests itself
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gkg

79. CONSERVATIVE MANAGMENT
 Surgery can be delayed or avoided in situations
where the patient's medical status prohibits
operative treatment
 It is aimed at alleviating symptoms
 recumbent position
 Truss(relief in up to 65% of patients)
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gkg

80. EMERGENT
 The indications for emergent inguinal hernia
repair are:
 Incarcerated
 Strangulated inguinal hernias,
 Sliding hernias
9/6/2022 80
gkg

81. ABDOMINAL HERNIAS
 Definition
◦ Abdominal hernia is the protrusion of
peritoneum with its contents through an
abnormal opening in the abdominal wall.
◦ Tissue or organs may protrude through this
defect.
◦ Also called ventral hernias
gkg 81
9/6/2022

82.  Types of abdominal hernias depending on
their site
1.groin hernias (75%)
2.Umblical hernia
 3.Para-umblical hernia
4.Epigastric hernia
5.Incisional hernia
gkg 82
9/6/2022

83. CONT…
9/6/2022 83
gkg

84. CLINICAL MANIFESTATION
 common finding is a mass or bulge on the anterior
abdominal wall, which may increase in size with a
Valsalva maneuver
 Physical examination
 bulge on the anterior abdominal wall that may
reduce spontaneously, with recumbency, or
with manual pressure
 Incarceration
 strangulated, and perforation
9/6/2022 84
gkg

85. UMBLICAL HERNIA
 Occur at the umbilical ring and may either be
present at birth or develop gradually
 10 percent of all newborns
 Are more common in premature infants
 Most congenital umbilical hernias close
spontaneously by age 5 years
 Greater in African-American children
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gkg

86. CONT…
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gkg

87. EPIGASTRIC HERNIA REPAIR
 Occurs in the midline between the xiphoid process
and the umbilicus
 Contents – preperitoneal fat, omentum ,portion of
falciform ligament
 Commonly small, multiple
 complain of vague abdominal pain above the
umbilicus that is exacerbated with standing or
coughing and relieved in the supine position
9/6/2022 87
gkg

88. CONT…
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gkg

89. INCISIONAL HERNIA
 Incisional hernia and can be regarded as a wound
healing failure
 primary wound healing defects
 Obesity
 multiple prior procedures
 prior incisional hernias
 technical errors during repair
 Surgical management:
◦ primary vs mesh
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gkg

90. 9/6/2022 90
gkg