Hernia

UG Class

1. MANAGEMENTMANAGEMENT

OFOF

INGUINAL HERNIAINGUINAL HERNIA

2. MANAGEMENT OF INGUINAL MANAGEMENT OF INGUINAL
HERNIAHERNIA
INVESTIGATIONS
TREATMENT
PREVENTION

3. INVESTIGATIONSINVESTIGATIONS
ROUTINE
Haemoglobin
BT/CT
Total count,differential count,ESR
Urine – Albumin,sugar,deposits
Blood urea,blood sugar
Blood grouping/typing –for irreducible
hernia/huge hernia

4. INVESTIGATIONSINVESTIGATIONS
ANAESTHETIC PURPOSE
X-ray chest
ECG all leads

5. INVESTIGATIONSINVESTIGATIONS
USG ABDOMEN PELVIS
In old age – BPH , to calculate post voidal
urine (>100ml significant)
To find any mass

6. INVESTIGATIONSINVESTIGATIONS
HERNIOGRAPHY
Suspected hernia, but clinical diagnosis unclear
Procedure done under flouroscopy following injection
of contrast medium
Frontal and oblique radiographs are taken with and
without increased intra-abdominal pressure

7. HerniographyHerniography
Right direct inguinal hernia
Left indirect inguinal
hernia

8. TREATMENTTREATMENT
SRMMC vikrampsj S-unit V

9. Historical PerspectiveHistorical Perspective
15
th
century -
Castration with
wound
cauterization or
hernial sac
debridement

10. Treating the precipitating factors Treating the precipitating factors
FIRSTFIRST
Chronic bronchitis
Bronchial asthma
BPH  prostatectomy then hernia repair
Stricture urethra
Tuberculosis
Stop smoking

11. TRUSSTRUSS
Not curative
Hernia should be reducible
Contraindicated in case of irreducible
hernia,undesended testis,associated huge
hydrocele

12. TRUSSTRUSS

13. TRUSSTRUSS

14. SURGERIES FOR HERNIASURGERIES FOR HERNIA
HERNIOTOMY
HERNIORRHAPHY
HERNIOPLASTY

15. INDICATIONSINDICATIONS
HERNIOTOMY
Congenital hernia
Congenital hydrocoele (patent processus
vaginalis)
All paediatric age group & young adults

16. INDICATIONSINDICATIONS
HERNIORRHAPHY
Young adults with good muscle tone
Weak posterior wall
Dilated internal ring

17. INDICATIONSINDICATIONS
HERNIOPLASTY
Old age with poor muscle tone
Direct hernia
Huge indirect complete hernia

18. INDICATIONSINDICATIONS
KUNTZ PROCEDURE
Recurrent hernia
Old age

19. HERNIOTOMYHERNIOTOMY
Opening up the inguinal canal
Separation of sac from cord structures
Reducing the content
Transfixation and high ligation of sac
Excision of sac

20. herniotomyherniotomy

21. herniotomyherniotomy

22. herniotomyherniotomy

23. HERNIORRHAPHYHERNIORRHAPHY
Herniotomy
Narrowing of the deep ring with 2’0
prolene (LYTLE’S REPAIR)
Approximation of conjoint tendon with
inguinal ligament

24. Types of herniorrhaphyTypes of herniorrhaphy

25. Father of Modern Inguinal Father of Modern Inguinal
Hernia Repair - 1884Hernia Repair - 1884
EDUARDO BASSINI

26. BASSINI’S REPAIR
Opening the fasciatransversalis from pubic
tubercle to deep ring
Approximation with interrupted stitches of
silk
Approximation of conjoint tendon & upper
leaf of fasciatransversalis with inguinal
ligament & lower leaf of
fasciatransversalis

27. MODIFIED BASSINI
Not done nowadays
Fasciatransversalis is not opened

Approximation with continuous
interlocking stitch with prolene
Approximation of conjoint tendon with
inguinal ligament

28. SHOULDICE TECHNIQUE
Additional strength is given to the
posterior wall by “DOUBLE BREASTING”
the fasciatransversalis
Best among all anatomical repairs
(Herniorrhaphy)
Least recurrence

29. HERNIOPLASTYHERNIOPLASTY
Herniotomy
Strenthening of the posterior wall of
inguinal canal with autologous tissue or
foreign material
We use PROLENE MESH to bridge the gap
between inguinal ligament and conjoint
tendon
\

30. Types of hernioplastyTypes of hernioplasty

31. LICHTENSTEIN’S TENSION FREE
HERNIOPLASTY
Prolene mesh 16 X 10 cm size is taken &
fixed in the inguinal ligament
First bite  periosteum of pubic tubercle
& fix the mesh to a point beyond the deep
ring
Fix the mesh with inguinal ligament &
conjoint tendon using 1’0 or 2’0 prolene
without tension

32. LICHTENSTEIN’S TENSION FREE
HERNIOPLASTY
Used in all types of inguinal hernia

Least recurrence rates

33. Prolene meshProlene mesh

34. Laparoscopic mesh repairLaparoscopic mesh repair
Inlay mesh – approach through the
abdomen , mesh kept preperitoneally
Onlay mesh – mesh kept in the inguinal
canal in front of deep ring

35. Laparoscopic mesh repairLaparoscopic mesh repair
TAPP – Trans Abdominal Preperitoneal
Procedure
TEP – Total Extraperitoneal Procedure

36. Complications of hernia surgeryComplications of hernia surgery
Intra operative
Immediate post operative
Late
Laparoscopic complications

37. Intra operativeIntra operative
Injury to blood vessles (inferior epigastric
& femoral)
Injury to bowel & bladder
Injury to ilioinguinal & iliohypogastric
nerves
Injury to cord structures

38. Immediate post operativeImmediate post operative
Urine retention
Hematoma
Infection
Periosteitis of pubic tubercle
Post herniorrhaphy hydrocele

39. Late complicationsLate complications
Recurrence
Testicular atrophy if testicular artery is
damaged
obstruction

40. Lap Hernia ComplicationsLap Hernia Complications
Vascular Injuries
Visceral Injuries
Trocar Site Complications
Bowel Obstructions
Hypercarbia syndrome
Abdomen Compartment Syndrome

41. PREVENTIONPREVENTION
You can't prevent the congenital defect
that may lead to an inguinal hernia, but
the following steps can help reduce strain
on your abdominal muscles and tissues

42. Maintain a healthy weightMaintain a healthy weight

43. Emphasize high-fiber foodsEmphasize high-fiber foods

44. Lift heavy objects carefully or Lift heavy objects carefully or
avoid heavy lifting altogetheravoid heavy lifting altogether

45. Avoid constipation and straining Avoid constipation and straining
during bowel movements and during bowel movements and
urinationurination

46. Stop smokingStop smoking
SRMMC vikrampsj S-unit V