MANAGEMENT OF HERNIA

This is a last minute revision slides for final year practicals examination.

1. MANAGEMENT OF INGUINAL HERNIA AYESHA HUMA MBBS 4 TH YEAR 2K16 , SIMS

2. ❌NOT CURATIVE JUST TO PREVENT COMPLICATIONS IN SICK PATIENT INDICATION : Patient with comorbidities where surgery can’t be performed. Reducible hernia CONTRAINDICATIONS : Irreducible hernia Undescedent testis CONSERVATIVE MANAGEMENT

3. SURGICAL MANAGEMENT

4. INDICATIONS OF REPAIR PROCEDURES HERNIOTOMY HERNIORAPHY HERNIOPLASTY All pediatrics patients & Young adults. Indication : Congenital hernia & Congenital hydrocele (PPPV ) Young adults with good muscle tone Weak posterior wall Old age poor muscle tone & young patients also As Child is growing the Inguinal canal & muscles are growing therefore we can’t tie the muscles or place a mesh Dilated internal ring Direct hernia Huge indirect hernia GOLD STANDARD FOR HERNIA REPAIR

5. LAPAROSCOPIC SURGERY TOTAL EXTRAPERITONEAL REPAIR ( TEP ) Popular than TAPP ADV : Avoid creating pneumoperitoneum ( decrease risk of bowel injury & adhesion ) DISADV : Small working space therefore done by experienced surgeon Commonly done TRANS ABDOMINAL PERIPERITONEAL (TAPP ) Create pneumoperitoneum ADV : Large working space can be done by begginers. DisADV : increase risk of damage to adjacent structures ✔️ During TAPP take consent to repair if hernia is seen on opp side as working space is huge it can be visible

6. COMPLICATIONS INTRAOPERATIVE EARLY LATE Injury to blood vessels ( Inf epigastric & femoral ) Injury to nerves ( II & IH ) Urine retention Hematoma Infection Recurrence Obstruction Testicular atrophy if testicular artery Is damaged Injury to bowel & bladder Injury to cord structures Periosteitis of public tubercle Post HERNIORAPHY hydrocele Seroma