An inguinal hernia is an abnormal protrusion of abdominal contents through the abdominal wall. Groin hernias are the most common type requiring surgery. Indirect inguinal hernias are more common than direct hernias and occur more often in males. Physical examination involves evaluating the hernia for position, size, reducibility, impulse on coughing, and ring occlusion to determine if surgical repair is needed. Laparoscopy is increasingly used for hernia repair and allows for improved visualization and techniques compared to open surgery.
1) Inguinal hernias are common, with approximately 700,000 repairs performed annually in the US, mostly occurring in males.
2) There are two main types of inguinal hernias - indirect and direct. Indirect hernias are congenital while direct hernias are acquired lesions that occur through the posterior inguinal wall.
3) Common surgical repair options include the Lichtenstein tension-free repair using mesh, the Shouldice repair with overlapping tissue layers, and laparoscopic repairs like TAPP and TEP which utilize a mesh placed laparoscopically.
Ventral hernias occur when abdominal contents protrude through weaknesses in the abdominal wall. There are several types of ventral hernias including umbilical, epigastric, incisional, and parastomal hernias. Incisional hernias occur through surgical scars and are more common with obesity, advanced age, and emergency surgeries. Treatment depends on hernia size but may involve primary repair for small defects or prosthetic mesh placement for larger defects. Laparoscopic repair is preferred when feasible due to benefits like fewer infections and shorter recovery.
An inguinal hernia occurs when part of the intestine or abdominal organs bulge through a weak spot in the abdominal wall in the groin area. There are two main types of inguinal hernia: direct and indirect. Direct hernias occur through a weakness in the abdominal wall muscles along the inguinal canal, while indirect hernias occur when the internal opening of the inguinal canal remains patent, allowing abdominal contents to slip into the canal. Symptoms include a bulge in the groin area and pain that is exacerbated by activities like coughing or straining. Treatment options are open hernia repair surgery or laparoscopic surgery to push the protruding tissue back into the abdomen and reinforce the weak
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.
This document provides an overview of abdominal wall hernias, including definitions, types, etiologies, anatomy, clinical features, and treatments. It describes the main types of groin hernias such as indirect, direct, and femoral hernias. It discusses the composition of hernias and provides classifications. For groin hernias specifically, it outlines the anatomy of the inguinal canal and contents, compares indirect and direct hernias, and describes surgical repair techniques like Bassini, Shouldice, and Lichtenstein. Femoral hernias are also summarized, including the anatomy of the femoral ring and canal.
This document provides information on various benign anorectal diseases. It discusses the anatomy of the rectum and anal canal and describes common conditions such as hemorrhoids, anal fissures, anorectal abscesses, anal fistulas, proctitis, pruritis ani, and rectal prolapse. For each condition, it covers definitions, causes, symptoms, examinations, investigations and treatments. The document also provides details on the clinical features, diagnosis and management of various anorectal diseases.
This document provides information on femoral triangle anatomy, femoral hernia, and umbilical hernia. It describes the boundaries of the femoral triangle and sheath. It then discusses the presentation, types, investigations, and surgical treatments of femoral hernia using various approaches like Lockwood, Lotheissen, and McEvedy. For umbilical hernia, it outlines the causes in children versus adults and various surgical repair techniques like Mayo's repair and mesh repair options based on hernia size and location.
1) Inguinal hernias are common, with approximately 700,000 repairs performed annually in the US, mostly occurring in males.
2) There are two main types of inguinal hernias - indirect and direct. Indirect hernias are congenital while direct hernias are acquired lesions that occur through the posterior inguinal wall.
3) Common surgical repair options include the Lichtenstein tension-free repair using mesh, the Shouldice repair with overlapping tissue layers, and laparoscopic repairs like TAPP and TEP which utilize a mesh placed laparoscopically.
Ventral hernias occur when abdominal contents protrude through weaknesses in the abdominal wall. There are several types of ventral hernias including umbilical, epigastric, incisional, and parastomal hernias. Incisional hernias occur through surgical scars and are more common with obesity, advanced age, and emergency surgeries. Treatment depends on hernia size but may involve primary repair for small defects or prosthetic mesh placement for larger defects. Laparoscopic repair is preferred when feasible due to benefits like fewer infections and shorter recovery.
An inguinal hernia occurs when part of the intestine or abdominal organs bulge through a weak spot in the abdominal wall in the groin area. There are two main types of inguinal hernia: direct and indirect. Direct hernias occur through a weakness in the abdominal wall muscles along the inguinal canal, while indirect hernias occur when the internal opening of the inguinal canal remains patent, allowing abdominal contents to slip into the canal. Symptoms include a bulge in the groin area and pain that is exacerbated by activities like coughing or straining. Treatment options are open hernia repair surgery or laparoscopic surgery to push the protruding tissue back into the abdomen and reinforce the weak
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.
This document provides an overview of abdominal wall hernias, including definitions, types, etiologies, anatomy, clinical features, and treatments. It describes the main types of groin hernias such as indirect, direct, and femoral hernias. It discusses the composition of hernias and provides classifications. For groin hernias specifically, it outlines the anatomy of the inguinal canal and contents, compares indirect and direct hernias, and describes surgical repair techniques like Bassini, Shouldice, and Lichtenstein. Femoral hernias are also summarized, including the anatomy of the femoral ring and canal.
This document provides information on various benign anorectal diseases. It discusses the anatomy of the rectum and anal canal and describes common conditions such as hemorrhoids, anal fissures, anorectal abscesses, anal fistulas, proctitis, pruritis ani, and rectal prolapse. For each condition, it covers definitions, causes, symptoms, examinations, investigations and treatments. The document also provides details on the clinical features, diagnosis and management of various anorectal diseases.
This document provides information on femoral triangle anatomy, femoral hernia, and umbilical hernia. It describes the boundaries of the femoral triangle and sheath. It then discusses the presentation, types, investigations, and surgical treatments of femoral hernia using various approaches like Lockwood, Lotheissen, and McEvedy. For umbilical hernia, it outlines the causes in children versus adults and various surgical repair techniques like Mayo's repair and mesh repair options based on hernia size and location.
This document discusses abdominal wall hernias. It defines hernias as the protrusion of a viscus or part of it through a defect in the abdominal wall. It describes the surgical anatomy of hernias and classifies them based on etiology, anatomy, and clinical presentation. Specific hernias discussed in detail include inguinal hernias, femoral hernias, and umbilical hernias. Diagnosis and management approaches are provided for each type of hernia.
The document discusses the anatomy and types of inguinal hernias. It describes the superficial and deep inguinal rings, differences in infants and adults, and contents that pass through the inguinal canal in males and females. It details characteristics of indirect, direct, sliding, and femoral hernias. Risk factors, signs, and surgical treatment are outlined. Strangulated hernias are also summarized, including contents, risk factors, and management approach.
Dr. Shirish Silwal provides a summary of different types of hernias including inguinal, umbilical, paraumbilical, incisional, epigastric, spigelian, and lumbar hernias. The document discusses the history, anatomy, causes, presentations, complications, and management approaches for each hernia type. Meshes are recommended for repair when there is a large defect size, multiple defects, or lax abdominal walls to create a tension-free repair and reduce recurrence rates.
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.
Seminar presentation by 5th year Medical Student under the supervision of a pediatric surgery specialist from HRPZ II. Reference as mentioned in the slide.
Laparoscopic Ventral Hernia Repair Ppt. DR DILIP S.RAJPALdiliprajpal
This document discusses laparoscopic ventral hernia repair (LVHR). It describes the surgical technique for LVHR, including accessing the abdominal cavity through ports, adhesiolysis, measuring and placing the mesh, and fixing it in place. Proper port placement and handling of meshes like Physiomesh and Proceed are emphasized to minimize infection risk. Wide mesh overlap and transfascial sutures are recommended to prevent mesh migration. Fixation techniques like double crowning help reduce seroma formation. Post-operative port site hernias are also mentioned.
This document discusses hernias, including inguinal hernias. It defines a hernia as the abnormal protrusion of an organ or tissue through a weak area in the muscle or surrounding wall. It then discusses the causes, types, anatomy, clinical features, differential diagnosis and treatment of inguinal hernias. The two main types of inguinal hernia are indirect and direct, which differ in their origin site and contents. Examination involves checking for reducibility, cough impulse and distinguishing between direct and indirect types. Treatment options include conservative management or surgery.
1. Inguinal hernia repair is the most common operation performed in the United States, with 75% of abdominal wall hernias occurring in the groin region. Inguinal hernias are more common in males, with a peak incidence before age 1 and after age 40.
2. Inguinal hernias can be direct, indirect, or femoral based on their anatomical location. Surgical repair with mesh is the definitive treatment, while conservative management with trusses is not recommended due to risk of complications.
3. Incarcerated or strangulated hernias require emergent surgery, while asymptomatic or minimally symptomatic hernias can often be initially managed non-oper
A brief presentation on inguinal hernia covering the all aspects regarding anatomy, presentation, treatment and complications, esp for undergraduate and post graduate students.
This document discusses ileosigmoid knotting (ISK), a rare cause of bowel obstruction. ISK occurs when a loop of the ileum or sigmoid colon wraps around the base of the other, causing a double closed loop obstruction. It presents diagnostic challenges and can lead to gangrene within hours if not treated. Surgical intervention is usually required and involves resection of any gangrenous bowel segments with primary anastomosis or stoma placement. Outcomes are poorer in older patients or those with gangrene or delayed presentation.
Spigelian hernia is a rare type of hernia that occurs in the Spigelian fascia of the abdominal wall. It was first described in the 17th century by Adriaan van den Spiegel. Spigelian hernias account for about 1% of all ventral hernias. They most commonly occur in adults ages 40-70 and present with pain. Diagnosis can be challenging as physical exam may not reveal a bulge. Imaging like ultrasound or CT can help identify the hernia defect. Treatment options include open herniorrhaphy or laparoscopic repair with mesh. Laparoscopy is preferred to minimize morbidity and allow for treatment of other hernias if present. Recurrence after
Approximately 75% of abdominal wall hernias occur in the groin.
The lifetime risk of inguinal hernia is 27% in men and 3% in women.
And hence Of inguinal hernia repairs, 90% are performed in men, and 10% are performed in women.
The incidence of inguinal hernia in men has a distribution, with peaks before the first year of life and after age 40.
Indirect inguinal and femoral hernias occur more commonly on the right side.
This is attributed to a delay in atrophy of the processus vaginalis after the normal slower descent of the right testis to the scrotum during fetal development.
The predominance of right-sided femoral hernias is thought to be caused by the tamponading effect of the sigmoid colon on the left femoral canal
The prevalence of hernias increases and the likelihood of strangulation and need for hospitalization increase with aging.
This document discusses different types of ventral hernias, including umbilical, epigastric, incisional, and paraumbilical hernias. It describes the causes, clinical features, diagnosis, and treatment options for each type. For treatment, it compares open surgical repair techniques like primary closure or mesh placement versus laparoscopic approaches. Complications of surgery like seroma, infection, and injury are also reviewed.
This document provides an overview of benign anorectal diseases. It begins with the anatomy of the anorectum and anal canal, including structures like the anal sphincter. It then discusses conditions like hemorrhoids, anal fissures, anorectal abscesses, and fistulas. For each condition, it covers topics like etiology, classification, clinical presentation, examination findings, and treatment options both non-surgical and surgical. The document provides detailed information on procedures for these various anorectal conditions.
Femoral hernias occur when abdominal contents protrude through the femoral canal in the groin. They are less common than inguinal hernias but more common in females, especially multiparous women. Contents can include fat, lymphatics, and the lymph node of Cloquet. Femoral hernias are often missed on examination and can become obstructed or strangulated, causing pain, tenderness, and vomiting. Surgical repair options include open techniques like the Lockwood Low operation through a transverse incision or laparoscopic approaches using mesh.
An inguinal hernia is a protrusion of abdominal contents through the musculoaponeurotic wall of the inguinal canal. Indirect inguinal hernias are the most common type seen. The inguinal canal contains the spermatic cord in males and traverses the abdominal wall, providing a potential weakness. Surgical repair is the main treatment and involves reducing the hernia contents and reinforcing the abdominal wall defect, often with mesh, to prevent recurrence. Complications can include pain, infection, and rarely incarceration or strangulation of hernia contents.
Laparoscopic anatomy of inguinal canalGergis Rabea
This document provides an in-depth overview of the anatomy of the inguinal region as viewed laparoscopically. It describes key anatomical landmarks such as Cooper's ligament, the umbilical artery, and epigastric vessels that define the spaces where direct and indirect inguinal hernias occur. Understanding the complex relationships between osseofascial, vascular, and visceral structures in the preperitoneal space is essential to avoid injury during laparoscopic hernia repair.
Inguinal hernia presentation
by Shariatyfar MD
based on schwartz principles of surgery 11th edition
Qom university of medical sciences
winter 2017
email me at Mohammadali.shariatyfar@hotmail.com for Download
Good luck
Hernias (as an inguinal hernia, umbilical hernia, or spigelian hernia) in which an anatomical part (as a section of the intestine) protrudes through an opening, tear, or weakness in the abdominal wall musculature.
James Cook MD2012 GIMN Week 1 IS notes.pptxShivSookun
This document provides an overview of the inguinal canal and posterior abdominal wall. It discusses the descent of the testes through the inguinal canal and structures that pass through. Hernias that can occur when abdominal contents protrude through weaknesses in the abdominal wall are also described. The document further outlines the major blood vessels, nerves, lymphatics and organs of the posterior abdominal wall.
This document discusses abdominal wall hernias. It defines hernias as the protrusion of a viscus or part of it through a defect in the abdominal wall. It describes the surgical anatomy of hernias and classifies them based on etiology, anatomy, and clinical presentation. Specific hernias discussed in detail include inguinal hernias, femoral hernias, and umbilical hernias. Diagnosis and management approaches are provided for each type of hernia.
The document discusses the anatomy and types of inguinal hernias. It describes the superficial and deep inguinal rings, differences in infants and adults, and contents that pass through the inguinal canal in males and females. It details characteristics of indirect, direct, sliding, and femoral hernias. Risk factors, signs, and surgical treatment are outlined. Strangulated hernias are also summarized, including contents, risk factors, and management approach.
Dr. Shirish Silwal provides a summary of different types of hernias including inguinal, umbilical, paraumbilical, incisional, epigastric, spigelian, and lumbar hernias. The document discusses the history, anatomy, causes, presentations, complications, and management approaches for each hernia type. Meshes are recommended for repair when there is a large defect size, multiple defects, or lax abdominal walls to create a tension-free repair and reduce recurrence rates.
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.
Seminar presentation by 5th year Medical Student under the supervision of a pediatric surgery specialist from HRPZ II. Reference as mentioned in the slide.
Laparoscopic Ventral Hernia Repair Ppt. DR DILIP S.RAJPALdiliprajpal
This document discusses laparoscopic ventral hernia repair (LVHR). It describes the surgical technique for LVHR, including accessing the abdominal cavity through ports, adhesiolysis, measuring and placing the mesh, and fixing it in place. Proper port placement and handling of meshes like Physiomesh and Proceed are emphasized to minimize infection risk. Wide mesh overlap and transfascial sutures are recommended to prevent mesh migration. Fixation techniques like double crowning help reduce seroma formation. Post-operative port site hernias are also mentioned.
This document discusses hernias, including inguinal hernias. It defines a hernia as the abnormal protrusion of an organ or tissue through a weak area in the muscle or surrounding wall. It then discusses the causes, types, anatomy, clinical features, differential diagnosis and treatment of inguinal hernias. The two main types of inguinal hernia are indirect and direct, which differ in their origin site and contents. Examination involves checking for reducibility, cough impulse and distinguishing between direct and indirect types. Treatment options include conservative management or surgery.
1. Inguinal hernia repair is the most common operation performed in the United States, with 75% of abdominal wall hernias occurring in the groin region. Inguinal hernias are more common in males, with a peak incidence before age 1 and after age 40.
2. Inguinal hernias can be direct, indirect, or femoral based on their anatomical location. Surgical repair with mesh is the definitive treatment, while conservative management with trusses is not recommended due to risk of complications.
3. Incarcerated or strangulated hernias require emergent surgery, while asymptomatic or minimally symptomatic hernias can often be initially managed non-oper
A brief presentation on inguinal hernia covering the all aspects regarding anatomy, presentation, treatment and complications, esp for undergraduate and post graduate students.
This document discusses ileosigmoid knotting (ISK), a rare cause of bowel obstruction. ISK occurs when a loop of the ileum or sigmoid colon wraps around the base of the other, causing a double closed loop obstruction. It presents diagnostic challenges and can lead to gangrene within hours if not treated. Surgical intervention is usually required and involves resection of any gangrenous bowel segments with primary anastomosis or stoma placement. Outcomes are poorer in older patients or those with gangrene or delayed presentation.
Spigelian hernia is a rare type of hernia that occurs in the Spigelian fascia of the abdominal wall. It was first described in the 17th century by Adriaan van den Spiegel. Spigelian hernias account for about 1% of all ventral hernias. They most commonly occur in adults ages 40-70 and present with pain. Diagnosis can be challenging as physical exam may not reveal a bulge. Imaging like ultrasound or CT can help identify the hernia defect. Treatment options include open herniorrhaphy or laparoscopic repair with mesh. Laparoscopy is preferred to minimize morbidity and allow for treatment of other hernias if present. Recurrence after
Approximately 75% of abdominal wall hernias occur in the groin.
The lifetime risk of inguinal hernia is 27% in men and 3% in women.
And hence Of inguinal hernia repairs, 90% are performed in men, and 10% are performed in women.
The incidence of inguinal hernia in men has a distribution, with peaks before the first year of life and after age 40.
Indirect inguinal and femoral hernias occur more commonly on the right side.
This is attributed to a delay in atrophy of the processus vaginalis after the normal slower descent of the right testis to the scrotum during fetal development.
The predominance of right-sided femoral hernias is thought to be caused by the tamponading effect of the sigmoid colon on the left femoral canal
The prevalence of hernias increases and the likelihood of strangulation and need for hospitalization increase with aging.
This document discusses different types of ventral hernias, including umbilical, epigastric, incisional, and paraumbilical hernias. It describes the causes, clinical features, diagnosis, and treatment options for each type. For treatment, it compares open surgical repair techniques like primary closure or mesh placement versus laparoscopic approaches. Complications of surgery like seroma, infection, and injury are also reviewed.
This document provides an overview of benign anorectal diseases. It begins with the anatomy of the anorectum and anal canal, including structures like the anal sphincter. It then discusses conditions like hemorrhoids, anal fissures, anorectal abscesses, and fistulas. For each condition, it covers topics like etiology, classification, clinical presentation, examination findings, and treatment options both non-surgical and surgical. The document provides detailed information on procedures for these various anorectal conditions.
Femoral hernias occur when abdominal contents protrude through the femoral canal in the groin. They are less common than inguinal hernias but more common in females, especially multiparous women. Contents can include fat, lymphatics, and the lymph node of Cloquet. Femoral hernias are often missed on examination and can become obstructed or strangulated, causing pain, tenderness, and vomiting. Surgical repair options include open techniques like the Lockwood Low operation through a transverse incision or laparoscopic approaches using mesh.
An inguinal hernia is a protrusion of abdominal contents through the musculoaponeurotic wall of the inguinal canal. Indirect inguinal hernias are the most common type seen. The inguinal canal contains the spermatic cord in males and traverses the abdominal wall, providing a potential weakness. Surgical repair is the main treatment and involves reducing the hernia contents and reinforcing the abdominal wall defect, often with mesh, to prevent recurrence. Complications can include pain, infection, and rarely incarceration or strangulation of hernia contents.
Laparoscopic anatomy of inguinal canalGergis Rabea
This document provides an in-depth overview of the anatomy of the inguinal region as viewed laparoscopically. It describes key anatomical landmarks such as Cooper's ligament, the umbilical artery, and epigastric vessels that define the spaces where direct and indirect inguinal hernias occur. Understanding the complex relationships between osseofascial, vascular, and visceral structures in the preperitoneal space is essential to avoid injury during laparoscopic hernia repair.
Inguinal hernia presentation
by Shariatyfar MD
based on schwartz principles of surgery 11th edition
Qom university of medical sciences
winter 2017
email me at Mohammadali.shariatyfar@hotmail.com for Download
Good luck
Hernias (as an inguinal hernia, umbilical hernia, or spigelian hernia) in which an anatomical part (as a section of the intestine) protrudes through an opening, tear, or weakness in the abdominal wall musculature.
James Cook MD2012 GIMN Week 1 IS notes.pptxShivSookun
This document provides an overview of the inguinal canal and posterior abdominal wall. It discusses the descent of the testes through the inguinal canal and structures that pass through. Hernias that can occur when abdominal contents protrude through weaknesses in the abdominal wall are also described. The document further outlines the major blood vessels, nerves, lymphatics and organs of the posterior abdominal wall.
Hernias definition, types, surgical anatomy of inguinal herniaUjala Abdul Rashid
Hernias Definition, Clinical and anatomical classification, surgical anatomy of the inguinal canal and related structures, Inguinal hernias and their types; the difference between direct and indirect inguinal hernias.
This document provides an overview of inguinal hernias, including:
- The anatomy of the inguinal canal and its role in hernia formation.
- The types of inguinal hernias including direct, indirect, and variants.
- The epidemiology, etiology, presentation, classification, and investigations of inguinal hernias.
- Treatment approaches including conservative management with trusses as well as various surgical repair techniques like herniotomy, herniorrhaphy, and hernioplasty.
This document discusses hernias, including definitions, causes, types of abdominal wall hernias, and details on inguinal and femoral hernias. It defines a hernia as a protrusion of an organ or tissue through an abnormal opening. The main types of abdominal wall hernias are inguinal, femoral, obturator, sciatic, and lumbar. Inguinal hernias are further classified as direct or indirect. Femoral hernias have a high risk of strangulation due to their narrow neck. Both inguinal and femoral hernias require surgical repair to prevent complications like obstruction, incarceration, and strangulation.
This document discusses abdominal wall hernias, including:
1. Inguinal hernias are the most common type, usually occurring in young men. Risk factors include straining, heavy lifting, and chronic coughing.
2. Hernias can be classified based on location, contents, reducibility, and whether the bowel is obstructed or strangulated.
3. Physical exam involves assessing the hernia for size, tenderness, impulse on coughing, and reducibility. Imaging may be used but diagnosis is usually clinical.
4. Treatment involves surgical repair to reinforce the weakened area, with common techniques including Shouldice, McVay, and Bassini repairs.
This presentation provides an overview of the gross anatomy of the inguinal canal, a passage in the lower abdomen that allows the spermatic cord (in males) or round ligament (in females) to pass from the abdomen to the scrotum (in males) or labia majora (in females). The presentation includes images and diagrams to help explain the anatomy of the inguinal canal
This document discusses the anatomy and clinical presentation of inguinal hernias. It describes the boundaries and contents of the inguinal canal, as well as structures like the superficial and deep inguinal rings. There are three main types of inguinal hernias - indirect, direct, and sliding. Indirect hernias are more common and involve a defect in the processus vaginalis. Direct hernias involve a weakness in the posterior inguinal wall. Hernia contents can include omentum, intestine, bladder, or other organs. Clinical presentation may include a groin bulge or heaviness, with pain or other symptoms if incarcerated or strangulated.
This document provides an overview of the anatomy of the anterior abdominal wall and types of ventral hernias. It describes the layers of the anterior abdominal wall including skin, superficial and deep fascia, external oblique, internal oblique, transversus abdominis, transversalis fascia, and rectus abdominis muscles. It then discusses various types of ventral hernias including umbilical, epigastric, incisional, lumbar, and Spigelian hernias. Risk factors, clinical features, and approaches to repair are summarized for each hernia type.
This document provides an overview of hernias, including their classification, anatomy, types, clinical presentation, and management. Hernias are classified based on their location (abdominal wall, groin, pelvic, flank) and etiology (congenital, acquired). The anatomy of the abdominal wall and groin region is described in detail. Common types of abdominal wall hernias include ventral, incisional, umbilical, epigastric and Spigelian hernias. Groin hernias are classified as indirect or direct inguinal hernias and femoral hernias. Clinical presentations can vary from reducible lumps to irreducible, obstructed, or strangulated hernias.
This document provides information about hernias, including their classification, anatomy, types, presentations, and management. Hernias are classified based on location (abdominal wall, groin, pelvic, flank) and etiology (congenital, acquired). Abdominal wall hernias include ventral, groin, and pelvic hernias. Ventral hernias occur in the abdominal wall and include epigastric, umbilical, incisional, and Spigelian hernias. Groin hernias include inguinal and femoral hernias. Clinical presentation depends on the type of hernia, and management involves repair or resection depending on symptoms. Risk factors and differential diagnosis are
The inguinal canal is a passage through the lower anterior abdominal wall that allows structures to pass between the abdomen and scrotum in males or labia in females. It contains the spermatic cord in males which includes the vas deferens, blood vessels and nerves. The inguinal canal has anterior and posterior walls formed from the external oblique muscle and fascia transversalis respectively. It transmits the ilioinguinal nerve in both sexes. Inguinal hernias occur when abdominal contents bulge through weak areas of the inguinal canal walls.
This document provides an overview of a seminar presentation on scrotal swellings and groin hernias. The presentation will be given by three presenters and moderated by Dr. Bizuayehu at Arba Minch Hospital. Topics that will be covered include the definition of hernia, types of hernia, anatomy of groin hernia, etiology, clinical presentation, differential diagnosis, investigation, complications, and management. The presentation will also discuss specific conditions like hydrocele, hematocele, varicocele, epididymal cyst, testicular torsion, and testicular tumors.
A hernia is a protrusion of an organ or tissue through a weakness in the wall of the cavity it is contained within. Common abdominal hernias include inguinal, umbilical, incisional, femoral, and epigastric hernias. An inguinal hernia, the most common type, can be direct or indirect and occurs when abdominal contents protrude through the inguinal canal. Risk factors for hernias include straining, obesity, pregnancy, coughing, and congenital abnormalities. Hernias can be irreducible, incarcerated, obstructed, or strangulated depending on whether the contents can be reduced and if the blood supply is compromised. Surgical repair options include open tissue or
SLOFT (Submucosal Ligation Of Fistula Tract) is new minimally invasive method to treat fistula in ano. It is closure of internal opening, It is modification of LIFT with more simplicity, reproducibility and no limitations of those of LIFT
This document discusses different types of hernias including common hernias like inguinal, umbilical, femoral, and incisional hernias as well as rare hernias. It covers the anatomy, causes, signs and symptoms, and treatment options for various hernias. The most common hernia is the inguinal hernia. Treatment is generally surgical though some hernias can be managed conservatively with a truss. Strangulated hernias require emergency surgery.
This document provides tips for using a PowerPoint presentation (ppt) for teaching purposes. It recommends:
1. Showing blank slides first to elicit what students already know about the topic before revealing information on subsequent slides.
2. Repeating this process of showing blank slides, asking questions, and then filling in information 3 times for active learning.
3. This technique can also be used for self-study by displaying blank slides to self-quiz before reading provided content.
The document then lists learning objectives and an outline of topics to be covered regarding inguinal hernia, including definitions, relevant anatomy, etiology, pathophysiology, classification, clinical features, investigations, management, controversies
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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Osteoporosis is an increasing cause of morbidity among the elderly.
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3. GENERAL CONSIDERATIONS
• Are the most common conditions s requiring major
surgery
• Have a significant rate of surgical failure
• Requires accurate anatomical knowledge with surgical
skills
• In the US, 96% of hernias are inguinal, 4% femoral,
20% bilateral Indirect hernias are most common in both
sexes
• Male to female ratio is 9:1 for inguinal hernias, 1:3 for
6. GENERAL FEATURES
• External- when the sac protrudes completely through
the abdominal wall
• Inter-parietal- the sac is contained in the abdominal
wall
• Internal- the sac is within the visceral cavity
• Reducible vs irreducible
8. POSITION
• The inguinal region (groin) is the
lower part of the anterior
abdominal wall extending between
the ASIS and pubic tubercle
9. SURGICAL IMPORTANCE
• Inguinal region is an important area anatomically and clinically
• Anatomically
• because it is a region where structures exit and enter the abdominal cavity
• Clinically
• because the pathways of exit and entrance are potential sites of herniation
10. WHAT ARE THE POTENTIAL WEAK
AREAS IN THE INGUINAL REGION
• The inguinal region is the weak part of the abdominal wall by the
presence of the:-
• Superficial inguinal ring
• Deep inguinal ring
• Inguinal canal
• Hesselbach’s triangle
11.
12. SUPERFICIAL INGUINALRING
• Triangular opening in the
aponeurosis of the external oblique
muscle
• Lies immediately (1.25cm) above
and medial to the pubic tubercle
13. DEEP INGUINALRING
• U-shaped condensation of the
transversalis fascia
• Lies 1.25cm above the mid-inguinal
point (ASIS symphisis pubis)
• Lateral to the inferior epigastric
vessels
18. CONTENTS
• 3 coverings
• Internal spermatic fascia (derived from transversalis fascia)
• Cremasteric fascia (derived from internal oblique)
• External spermatic fascia (derived from external oblique aponeurosis)
• 3 nerves
• Ilioinguinal nerve
• Genital branch of Genitofemoral nerve
• Sympathetic fibres from T10-11 spinal segments
19. CONTENTS…….
• 3 arteries
• Testicular artery
• Artery of the vas
• Cremasteric artery
• 3 veins
• Pampiniform plexus of veins
• Cremasteric vein
• Vein of the vas
• 3 others
• Vas deferens
• Lymphatic vessels of the testis
• A patent processus vaginalis in patients with indirect hernia
20.
21. HESSELBACH’S TRIANGLE
• Boundaries
• Supero-lateral border
• Inferior epigastric vessels
• Medial border
• The lateral border of the rectus
sheath
• Inferior border
• Inguinal ligament
• Direct hernias occur within the
Hesselbach’s triangle, whereas
indirect inguinal hernias arise
lateral to the triangle
23. INCIDENCE
• Worldwide, inguinal Hernias account for up to 75% of all anterior
abdominal hernias
• 2/3 of these are indirect, and the remaining 1/3 are direct inguinal hernias
24. AGE
• Generally, the prevalence of inguinal hernias increases with age
• Indirect hernia is more common in children and young adult while direct hernia is common in elderly
individuals
• Most serious complication of inguinal hernia- 1-3% develop strangulation
• Femoral hernia have the highest rate of complication- 15-20%, repair recommended at the earliest time of
discovery
25. SEX
• Men are 25 times more likely to have a groin hernia than women
• An indirect inguinal hernia is the most common hernia, regardless of gender
• In men, indirect hernias predominate over direct hernias at a ratio of 2:1
• Direct hernias are very uncommon in women
27. CONGENITAL CAUSES
• Developed from preformed hernial sac as a result of persistent processus vaginalis
• All indirect inguinal hernia belongs to this type
28. ACQUIRED CAUSES
• intra-abdominal pressure
• Chronic cough
• Straining
• Obstructive uropathy
• Chronic constipation
• Lifting heavy objects
• Weakness of abdominal wall due:-
• Acquired deficiency of collagens
• Damage to the ilioingiunal nerve
• Recurrent inguinal hernia
30. ETIOLOGICAL CLASSIFICATION
• Congenital inguinal hernia
• It is due to persistence of processus vaginalis
• Developed from a pre-formed sac
• Reaches the scrotum very quickly
• All indirect inguinal hernia belongs to this type
• Acquired inguinal hernia
• Occurring later in life as a result of underlying weakness of the abdominal muscles
• Most of direct inguinal hernias are of acquired type
32. ACCORDING TO ITS SITE OF EXIT
• Indirect
• Comes through deep inguinal ring lateral to the inferior
epigastric artery
• Direct
• Comes out through the Hesselbach’s triangle
• The neck of the sac lies medial to the inferior epigastric artery
33. MYOPECTINEAL ORIFICE OF
FRUCHAUD
• According to (Bittner , 2018, p. 31), the boundaries are:
• Superiorly- Arching fibers of the internal oblique and
tranversus abdominus muscles
• Medially- Rectus abdominus muscles and the rectus
sheath
• Inferiorly- Coopers ligament
• Laterally- Iliopsoas muscles
• Th inguinal ligament runs diagonally through the
myopectineal orifice
34.
35. FEATURES OF THE MYOEPITHELIAL
ORIFICE
• 4 cm in length
• 2-4cm cephalad to the inguinal ligament
• Extends between the superficial and deep rings
• Contains the spermatic cord or round ligament
36. ANATOMY OF THE MPO
• Superficially- External oblique
• Superiorly- Conjoint tendon
• Inferiorly-Inguinal ligament
• Floor- Transversalis fascia
38. LAYERS OF MPO
• The skin, subcutaneous, campers, Scarpa, external
spermatic fascia, cremaster, internal spermatic fascia,
preperitoneal tissues, peritoneum
39. HERNIAS BASED ON ANATOMICAL
SITE
• Broadly classified as indirect and direct depending on
relationship to the epigastric vessels
• Hesselbach’s triangle is:
• Lateral- Inferior Epigastric Artery
• Medially-Lateral border of Rectus
• Inferiorly- Inguinal Ligament
40. …
• An indirect hernia passes lateral to the Hesselbach’s
triangle
• A direct hernia passes through the Hesselbach’s
trainagle
• Indirect hernia has a congenial component- from the
processus vaginalis
• The processus is supposed to obliterate after descent
of testes
48. DIRECT INGUINAL HERNIA
• Medial to the inferior epigastric artery and vein, and
within the Hesselbach’s triangle
• Acquired weakness in the inguinal floor
• Usually not congenital
• Acquired by development of tissue deficiencies of the
transversalis facia
49. …
• Development of femoral hernias less understood
• Increased intrabdominal pressures
• The sac then migrates down the femoral vessels into
the thigh
50.
51.
52. NYLUS CLASSIFICATION
• I- indirect, internal ring normal (Kids)
• II- indirect, dilated internal ring
• III- Posterior wall defects, direct inguinal hernia,
dilated inguinal ring, massive scrotal, sliding, femoral
hernia
• IV-Recurrent hernia
53. ACCORDING TO THE EXTENT OF THE HERNIA
• Bubonocele inguinal hernia
• Hernia does not come out the superficial inguinal ring
• Funicular inguinal hernia
• Comes out through the SIR but does not reach the
bottom of the scrotum
• Complete inguinal hernia
• Reaches the bottom of the scrotum
54. ACCORDING TO THE CONTENTS
• Enterocoele (intestines)
• Omentocoele (omentum)
• Cystocoele (urinary bladder)
• Littre’s hernia (Meckel’s diverticulum)
• Richter’s hernia (part of the circumference of the bowel)
56. REDUCIBLE INGUINAL HERNIA
• Contents can be easily returned into the abdominal cavity leaving the hernial sac in its position
57. IRREDUCIBLE INGUINAL HERNIA
• Contents cannot be returned to the abdomen
• It is due to :-
• Adhesions of its contents to each other
• Adhesions of its contents with the sac
• Adhesions of one part of the sac to the other part
• Sliding hernia
• Very large scrotal hernia
58. OBSTRUCTED INGUINAL HERNIA
• Irreducible hernia + intestinal obstruction
• No interference with blood supply to the intestine
60. INFLAMED INGUINAL HERNIA
• Rare type
• Occurs when the contents of the hernia become inflamed and present with constitutional symptoms
associated with inflammation e.g. overlying skin become red, edematous, tenderness
• Differs from strangulated hernia not tense and not associated with intestinal obstruction
62. THE SAC
• This is the diverticulum of peritoneum consisting of a mouth, neck, the body and the fundus
• The mouth
• The neck
• The body
• The fundus
64. CONTENTS
• Omentum (omentocoele)
• Intestine (enterocoele)
• Part of the urinary bladder ( cystocoele)
• Ovaries
• Meckel’s diverticulum (Littre’s hernia)
• Part of the circumference of the intestine (Richter’s hernia)
• Fluids
65. MECHANISMSWHICH PREVENTINGUINALHERNIAFORMATION
• Obliquity of the inguinal canal opposes an intra-abdominal pressure [IAP]
• Shutter mechanisms of the arched fibres of the conjoined muscles opposes an
IAP as they contact
• Strong fibres of internal oblique in front of the deep inguinal ring prevent herniation
through it
• Strong conjoined tendon in front of Hesselbach’s triangle prevents direct hernia
• Action of the cremaster muscle pulls up the spermatic cord into the canal and plug it
during IAP
69. PATIENT CHARACTERISTICS
• Age
• Indirect inguinal hernia is common in young individual while direct inguinal hernia is common in the older
• Occupation
• Strenuous work is often responsible for development of hernia
70. MAIN SYMPTOMS
• Inguinal or inguinal swelling; note:-
• How long has the swelling been there?
• How did it start?
• Where did it 1st appear?
• What were the size + extent when it was first
seen?
• Congenital type: reaches the bottom of the
scrotum at its first appearance
• Acquired type: small to start and gradually
descend to reach the bottom of the
scrotum
• Does it disappear automatically on lying
down?
73. LOCAL EXAMINATION
• Position and extent
• To get above the swelling
• Consistency
• Impulse on coughing
• Reducibility
• Invagination test
• Ring occlusion test
74. POSITION AND EXTENT
• If the swelling reaches the scrotum or labia
majora it is an obviously inguinal hernia
• When confined to the groin, the hernia needs
to be differentiated from femoral hernia
• Two anatomical landmarks to be considered:
pubic tubercle +inguinalligament
• Inguinal hernia lies above the inguinal
ligament and medial to pubic tubercle
• Femoral hernia lies below the inguinal
ligament and lateral to the pubic tubercle
75.
76. TO GET ABOVE THE SWELLING
• To differentiate scrotal swelling from inguino-scrotal swelling
• The root of the scrotum is held between the thumb in front and other fingers behind in an attempt to reach
above the swelling
• One cannot get above the swelling in case of inguinal hernia, whereas in case of pure scrotal swelling e.g.
Hydrocoele one can get above the swelling
77. CONSISTENCY
• Omentocoele doughy and granular
• Enterocoele elastic
• Strangulated hernia tense and tender
78. IMPULSE ON COUGHING
• When a finger is placed over the SIR or when the root of the scrotum is held
between the index finger and the thumb and the patient asked to cough
an expansile impulse on coughing can be felt as the hernial contents will be
forced out through the SIR in case of reducible hernia
• Impulse on coughing is negative in case of:-
• Irreducible hernia
• Obstructed hernia
• Strangulated hernia
79. REDUCIBILITY
• The hernial contents is squeezed in the abdomen by holding the fundus of the sac gently using one
hand while the other hand is guiding the contents into the superficial inguinal ring
80. INVAGINATION TEST
• After reduction of the hernia one
can perform this test to know the
gap in the superficial inguinal
ring
• A little or the index finger is pushed
up gradually from the bottom of
scrotum to enter the superficial
inguinal ring
81. RING OCCLUSION TEST
• The hernia must be reduced first
• A thumb is placed on the deep inguinal ring i.e. 1.3cm above the mid-inguinal point
• The patient is asked to cough
• A direct hernia will show a budge medial to the occluding finger but an indirect hernia will not find access, so
no budge
91. NO TREATMENT
• This is indicated in a patient:-
• With severe general ill-health not suitable for anaesthesia
• With chronic bronchitis not cured by medicinal treatment
• With obstructive uropathy
• Who refuses surgery
92. TRUSS
• A truss does not cure a hernia, it is used to prevent the hernia to come out of the
superficial inguinal ring
• The requirements are:-
• The hernia should be easily reducible
• The patient should be reasonably intelligent
• Indications:-
• Very old patients suffering from diseases like chronic bronchitis, obstructive uropathy etc
• Patients who refuses surgery
• In children
97. HERNIOTOMY
• Commonly done in children < 10 years
• No repair of the posterior wall of the inguinal canal
• Patent processus vaginalis ligated at the origin at the internal ring (high ligation)
• Nyhus type I
98. HERNIORRHAPHY
• Herniotomy + repair of the posterior wall
• Nyhus type II and III
• High ligation and reinforcement of the weakness with patient’s own tissue
• Technique include
• Modified Bassini repair
• Shouldice repair
• Lichtenstein mesh repair
• Desarda hernial repair
• Darning hernial repair
101. SHOULDICE REPAIR
• Multilayer imbricated repair of the
posterior wall of the inguinal canal with a
continuous running suture technique:
• 1st suture line - transversus abdominis
aponeurotic arch to the iliopubic tract
• 2nd line - internal oblique and transversus
abdominis muscles and aponeuroses
(Conjoint) to the inguinal ligament
• 3rd line - Conjoint to Ext. oblique
• 4th line - Conjoint to Ext. oblique
108. DESARDA HERNIAL REPAIR
The medial leaf of the external oblique
aponeurosis is sutured to the Inguinal
ligament.
1) Medial leaf
2) Interrupted sutures taken to suture the
medial leaf to the inguinal ligament
3) Pubic tubercle
4)Abdominal ring
5) Spermatic cord
6) inguinal ligament
111. HERNIOPLASTY
• High ligation, inverted sac, and reinforcement of the
defect with synthetic material
• Tension-free
• Lichtenstein
112. TENSION-FREE REPAIR
• Similar approach as anterior repair
• Instead of sewing fascial layers together to repair the
defect, a prosthetic mesh onlay is used
• Suited for local anesthesia with excellent results in
terms of recurrence rate below 4%
113.
114.
115. • Coined by Liechtenstein in 1989
• Central feature is polypropylene mesh over the unrepaired floor
• Gilbert repair uses a cone shaped plug placed through the deep
ring
• Slit placed in mesh for cord structures
• Fixing the mesh to the rectus sheath 1-1.5 cm medial and
superior to pubic tubercle is very important
• A medial suture should be used to secure the surplus mesh
inferiorly
116. OPEN POSTERIOR REPAIR
• Divide the layers of the abdominal wall
superior o the internal ring, enter
preperitoneal space
• Dissection continues behind and deep to the
entire inguinal region
• There are challenges with tension suturing
118. IMPORTANT TRIANGLES IN
LAPARASCOPY
• Triangle of Doom
• Triangle of Disaster
• Trapezoid of Disaster
• Triangle of Pain ((Bittner , 2018, p. 31)
119.
120.
121.
122.
123. LAPARASCOPIC ANATOMY OF THE
INGUINAL REGION
• Recognize that the parietal peritoneum covers certain structures
forming five ligaments
• These ligaments include the median umbilical ligament, the medial
umbilical ligaments, the lateral umbilical ligaments
• The spatial relationships of these ligaments allow recognition of the
various types of hernias
• A view of the femoral hernia space can be seen below the iliopubic tract
and medial to the femoral vessels exiting through the femoral canal.
During the laparoscopic repair, the direct, indirect, and femoral spaces
should all be covered with mesh (Bittner , 2018, p. 31)
124. ANATOMICAL PRINCIPLES IN
LAPAROSCOPY
• The second important concept concerns the spaces that occur beneath the
peritoneal covering
• The preperitoneal space is the space bounded by the peritoneum posteriorly
and the transversalis fascia anteriorly
• The space of Retzius is that space between the pubis and the bladder
• The lateral extent of this space is named Bogros’ space
• The transversalis fascia forms the floor of the inguinal canal and the
iliopectineal arch, iliopubic tract, and crura of the deep inguinal ring
• The iliopectineal arch divides the vascular compartment (iliac vessels) from
the neuromuscular compartment (iliopsoas muscle, femoral nerve, and the
lateral femoral cutaneous nerve)
125. ANATOMICAL PRINCIPLES IN
LAPARASCOPY
• The iliopubic tract is an aponeurotic band that begins near the anterior superior iliac
spine and inserts on the pubic tubercle medially
• In its medial extent, it contributes to the formation of Cooper’s ligament
• It forms the inferior margin of the deep musculoaponeurotic layer made up of the
transversus abdominis muscle and aponeurosis and the transversalis fascia. Laterally,
it extends to the iliacus and psoas fascia
• It forms with fibers of the transversalis fascia, the anterior margin of the femoral
sheath and the medial border of the femoral ring and canal
• Its lower margin is attached to the inguinal ligament
• The iliopubic tract is an important landmark. Dissection or tacking of preperitoneal
mesh should not take place inferior to the iliopubic tract except in the limited region
of Cooper’s ligament (Yang & Liu, 2016, p. 372)
135. LAPARSCOPCI PROCEDURES
• Great for bilateral hernia, with no increase in morbidity
• For recurrent hernia
• Disadvantages of cost
136. REFERENCES
• Bittner , R. (2018). Laparoscopic view of surgical
anatomy of the groin. International Journal of
Abdominal Wall and Hernia Surgery, 1(1), 24-31.
doi:10.4103/ijawhs.ijawhs_1_18
• Yang, X.-F., & Liu, J.-L. (2016). Anatomy essentials for
laparoscopic inguinal hernia repair. Annals of
Translational Medicine, 372.