A hernia is the abnormal protrusion of an organ or tissue through a weakness or defect in the surrounding muscle or connective tissue that normally contains it.

Definition:
A hernia is the abnormal protrusion of an organ or tissue through a weakness or defect in the surrounding muscle or connective tissue that normally contains it. Hernias most commonly occur in the abdominal wall but can also develop in other areas of the body.

Types of Hernia:
Inguinal Hernia (Most common)

Occurs in the groin area due to weakness in the inguinal canal.
More common in men.
Indirect inguinal hernia: Passes through the deep inguinal ring into the scrotum.
Direct inguinal hernia: Protrudes directly through the abdominal wall.
Femoral Hernia

Occurs below the inguinal ligament in the femoral canal.
More common in women.
Higher risk of complications like strangulation.
Umbilical Hernia

Occurs around the belly button due to weakness in the umbilical ring.
Common in infants (congenital) and adults (due to obesity, pregnancy).
Incisional Hernia

Occurs at the site of previous surgical incisions where the muscle is weakened.
Common after abdominal surgeries.
Hiatal Hernia

Occurs when part of the stomach protrudes through the diaphragm into the chest cavity.
Associated with gastroesophageal reflux disease (GERD).
Epigastric Hernia

Occurs in the midline between the sternum and umbilicus.
Due to weakness in the linea alba.
Obturator Hernia

Protrudes through the obturator foramen in the pelvis.
Rare but more common in elderly, thin women.
Clinical Features:
Bulging or swelling at the site of the hernia.
Pain or discomfort, especially with straining, lifting, or coughing.
Reducibility: Hernia may disappear when lying down or with manual pressure.
Complications:
Incarceration: Hernia becomes trapped and cannot be reduced.
Strangulation: Blood supply is compromised, leading to necrosis and severe pain (surgical emergency).
Diagnosis:
Clinical examination: Cough impulse test, palpation of hernia site.
Imaging (if needed):
Ultrasound (for differentiating soft tissue masses).
CT scan or MRI (for complex or occult hernias).
Barium swallow & endoscopy (for hiatal hernia).
Treatment:
Conservative:
Watchful waiting in asymptomatic cases.
Lifestyle modifications (avoiding heavy lifting, weight loss).
Surgical Repair (Definitive Treatment):
Open Herniorrhaphy: Traditional surgical repair.
Laparoscopic Hernioplasty: Minimally invasive technique using mesh reinforcement.
Emergency surgery in cases of strangulation or obstruction.

1. Hernias of the abdomen
The department of the surgical diseases and transplantology of the
Urganch branch
of the Tashkent medical academy

2. Hernias of the abdomen – coming out of the internal organs from the
natural or pathologic aperture at the anterior abdominal wall into the
hypoderm or other cavities, covered with parietal peritoneum
Hypoderm
Intestine
Aperture
Parietal
peritoneum

3. Sliding hernias - are the hernias, at which one of the
walls of the hernia’s bag is the organ, partial covered with the
peritoneum (urine bladder, ascending and descending intestines)
1 - peritoneum; 2 - fascia transversalis; 3 – hernia’s
bag; 4 – wall of the caecum.

4. Elements of the hernia
1 – hernia’s gates
2 – hernia’s content
3 – hernia’s bag
4 – hernia’s shells
4
3
2
1

5. Frequency of finding out of the
hernias depend on age
частота
0
5
10
15
20
25
30
to 1 year
30-40 years 60 and elder
Death after planned operations – till 1%, after urgent – till 4%

6. Frequency of finding out of the
different types of the hernias
0%
20%
40%
60%
80%
Р1

7. Factors of the origin of the
hernias
local general
Particularities of the
anatomic construction
of the area of the
coming out of the
hernias:
Inguinal channel,
White line of the
abdomen and other.
Producing Promoting

8. Promoting factors of formation
of the hernias of the abdomen
•Heredity
•Age (children, elders)
•Gender (pelvis at women, inguinal channel at
men)
•Particularities of constitution (fast loss of weight)
•Frequently births
•Traumas of the anterior abdominal wall
•Paralysis of nerves

9. Producing of formation of the
hernias of the abdomen
Factors, increasing intraabdominal pressure
1.Constipations
2.Lasting cough
3.Hard physical work
4.Hard birth
5.Complicated urine evacuation (urethra’s stricture,
adenoma of prostate)

10. Classification of hernias
innate
External
Internal
gained
By the origin
By the anatomic localization
Femoral umbilicalInguinal Of white line
By the clinic currency
Not complicated (setting)
complicated
(unsetting, coprostasis,
strangulation, inflammation)

11. Complaints of the patients with
the hernias of the abdomen
•Presence of the formation in the area of
the hernia, appearing at the vertical state
or physical effort and disappearing at the
horisontal positoin
•Pain or sense of dyscomfort in the area of
hernia
•Seldom: sickness, constipation, ballooned
abdomen

12. Special methods of research
•Symptom of cough pushing –
At the coughing the finger of researcher
have a sense of pushing of coming out
peritoneum and nearest organs

13. Treatment of hernias
Conservative -
Wear bandage
Surgical
•At small children
•At the contraindications to
the surgical treatment
Contraindications:
Hard additional diseases
Offered Lequen (1663) and further
improved by Camper (1785) with the
special metallic spring.
1804 Cooper - “anatomy and surgical
treatment of the abdominal hernias”
E.Bassini – 1884 г. – created united
conception in the surgical treatment
of the inguinal hernia

14. Negative moments of wearing
bandage
•Atrophy of the tissues of the abdominal wall
•Formation of the soldering between hernia’s
gate and its content
•Increasing of the sizes of the hernia’s gates
•Maceration of the skin
•Dyscomphort

15. Stages of the operation at the Stages of the operation at the
setting herniassetting hernias
•Access
•Separation of the hernia’s bag
•Opening of the hernia’s gates
•Opening of the hernia’s bag
•Herniotomy
•Plastic of the hernia’s gates

16. Access at the inguinal hernias

17. Access at the umbilical hernias
1- by Sapejko
2- by Meyo
3- by Lexer

18. Separation of the hernia’s bag

19. Extension of the hernia’s gates

20. Opening of the hernia’s bag and
setting of the hernia’s content

21. Liquidation of the hernia’s bag

22. Sliding hernia
Danger at the sliding hernia – risk of defeat of the internal organs at
the opening of the hernia’s bag

23. Plastic of the hernia’s gates

24. Likhtenshteyn’s operation

25. Laparoscopic herniotomy

30. Prevention of the hernias
•Observance of the hygiene of small children.
•Constant physical effort and sport.
•Fight with the obesity and cachexy
•
•Adequate choose of workers depend on their state of
health.
•Earlier finding out people with the hernias of abdomen.