Surgery

1. Hernia
Lecture
S. Mutale

2. Introduction
• Definition
A protrusion of a viscus or part thereof
through a weakness in the abdominal wall

3. Classification
• Internal
• External hernia

4. Internal Hernia
• Hiatus
- Sliding
- Rolling

5. Internal hernia
• Para duodenal
• Para caecal (Retrocaecal)
• Mesenteric
• Spingelian

6. External Hernia
• Anatomical location
- Umbilical
- Paraumbilical
- Epigastric
- Groin (Inguinal, Femoral)
- Lumbar
- Obturator
- Incisional

7. 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

8. 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

9. 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

10. Causes
• Congenital
- Failure of closure of processus vaginalis
- Seen in premuture babies and those with
low birth weights

11. Acquired
• Chronic cough
• Constipation
• Lower urinary tract obstruction
• Subacute obstruction

12. Inguinal hernia
.

13. Life history
• Reducible
• Irreducible
• Obstructed
• Strangulated
• Gangrenous
• Perforation
• Peritonitis/Fistula

14. Management
• History
• Examination
• Investigation
• Surgery

15. Herniorrhaphy
• Herniotomy (to be discussed under
paediatric surgical conditions)

16. complication
• Bleeding
• Haematoma
• Infection
• Injury to the vas
• Orchitis

17. Operation
• Sutures removed after a week

18. - End -