Hernia

1. Hernia Dr. Rekha Pathak , Senior scientist, IVRI Def: Protrusion of body cavity contents Into normal / Abnormal opening in the wall of that cavity To lie beneath the intact skin or to occupy another body cavity

2. Constituent of hernia Ring, Sac and Contents H. Ring: Rupture of abdominal wall- Ventral hernia Diaphragm is the limiting wall: DH Normal opening/ Passage: Inguinal ring / canal

3. Sac In external hernia- Skin M.fibres Fibrous tissue Parietal peritoneum

4. Contents Intestine Omentum Liver Spleen Bladder uterus

5. Classification of hernia 1. OCCURRENCE Congenital Aquired 2. LOCATION: External : has ring , sac and contents Eg: ventral, lateral , inguinal (bubonocele), scrotal umblical(exomphalos, omphalocele) , perineal

6. Internal: no sac EG. DH, gut- tie (occasional) Interstitial : between the abdominal muscles

7. Classification of hernia 3. According to contents Enterocele Epiplocele Enteroepiplocele Gastrocele Reticulocele Vesicocele Hysterocele

8. Classification of hernia 4. Depending on cause : Traumatic H. Infectious H.

9. 5.Based on functional alteration Reducible- contents returned through ring into original position Irreducible – adhesions(sac and contents) Incarcerated - voluminous contents due to venous congestion Strangulated - necrosis and extensive adhesions

10. Diagnosis Symptoms: 1. Physical : Swelling – variable in size (abscess, hematoma , cyst, neoplasm )- aseptic exploration

11. Palpation of ring Consistency of sac: enterocele(elastic), epiplocele (doughy)

12. Diagnosis Functional symptom Absent in reducible and non- complicated hernia Colic in incarcerated hernia Severe pain, temp.etc

13. Radiography

14. Complications of hernia Adhesions Hydrocele of sac Incarceration-absorption of water in enterocele- making reduction difficult Torsion Strangulation-called as acute hernia

15. Umblical hernia Common in dogs and bovine calves Rare in lambs & kids No gender predisposition, among ruminants- common in females

16. Congenital/ aquired Congenial – hypoplastic rectus muscles and aponeurosis of oblique muscle(wide thin linea alba from xiphoid to pubis )- DH

17. Aquired: cord cut close to abdomen Bitch chews Rough handling Excessive straining(diarhoea/ constipation)

18. Infection of cord Congenital/ aquired – primarily hereditary – size- H.ring- recessive genes(2 or more)

19. Clinical signs Swelling Ring Contents – omentum / fat/ intestinal loop More voluminous content/ adhesions- ring not felt- RG diagnosis

20. Treatment Conservative: belly bandages/ wooden or metal clamps Reducible- small content Dorsal recumbency- reduce manually the contents- clamp the empty sac- jaw of clamp and tighten the nuts

21. Aim : to obliterate hernial sac – stimulate healing of the ring Sac – necrosis- sloughs down – 10- 12 days Skin wound- heals by 2 nd intention Inject irritants – HCL/ H2so4- around ring- stimulate fibrous tissue formation

22. Radical surgery 12-24 hrs fasting Local infiltration/GA Dorsal recumbency

23. Midline/ extended past craniocaudal limits on the ring

24. In large hernia- elliptical incision – removal of isolated skin

25. Open the sac More content and small ring- go for kelotomy

26. Reducible – invert the contents if large and adhesions: remove

27. Bet. Sac(inner wall) and contents Bet. Sac with skin/muscles Edge of ring – debrided If sac is big- remove the sac

28. Series of simple interrupted / horizontal mattress Chromic catgut/ silk / monofilament/ steel/ nylon Overlapping mattress- non – absorbable- tighten from centre to periphery

29. Wide wall disruption- tension on apposition of edges To relieve- external laminae of rectus sheath- incised on each side of incision – relieve tensionand achieve apposition of sutured H. ring Alternatively, Hernioplasty

30. Hernioplasty (Hernial Prosthesis) Large h. ring Weak spot(scar) present Large loss of tissue on edges Allow approximation without tension Bridge the gap Avoid reccurrence of hernia

31. Living (fresh and preserved) Skin- full thickness, autologous whole skin graft (DH) Duramatter Muscle Fascia lata- lumbar area- no tissue reaction

32. Non – living Metallic : stainless steel Synthetic: Nylon, teflon, Marseline, Marlex, dacron, etc Mesh/sheets

33. Mesh – prefferred More flexibility Permits infiltrative fibrosis- scaffold – ingrowth- fibrous CT Minimal tissue reaction and adequate strength 15x30 cm

34. Techique Remove sharp ends and corner Close muscle defect Edge of mesh – sutured- surrounding fascia with non- absorbable material in a horizontal mattress pattern Close the skin