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ABDOMINAL HERNIAS

ABDOMINAL HERNIAS . ANEEKA ZIA . WHAT IS HERNIA???. Protrusion of a viscus or a part of a viscus through an abnormal opening in the walls of its containing cavity. CLASSIFICATION. According to site: Epigastric Umbilical Paraumblical Inguinal Femoral Sliding hernia of stomach.

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ABDOMINAL HERNIAS

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  1. ABDOMINAL HERNIAS ANEEKA ZIA

  2. WHAT IS HERNIA??? • Protrusion of a viscus or a part of a viscus through an abnormal opening in the walls of its containing cavity

  3. CLASSIFICATION • According to site: • Epigastric • Umbilical • Paraumblical • Inguinal • Femoral • Sliding hernia of stomach

  4. RARER TYPES • Inter parietal • Spigelian • Lumbar • Gluteal & Sciatic

  5. TYPES OF HERNIA • Congenital vs acquired • Complete vs incomplete • Internal vs external • Intraparietal,spigelian • Unilateral vs bilateral

  6. Reducible • Irreducible • Obstucted • Strangulated • Inflamed

  7. COMPOSITION • Sac: • Diverticulum of peritoneum • Neck,body,fundus • Narrow neck (femoral, paraumblical) • Coverings: • Contents: • Omentum ,omentocele • Intestine ,enterocele • Circumference of intestine, Richter’s • Bladder • Ovary +/_ fallopian tube • Meckel’s diverticulum, Littre’s • Fluid ,ascites

  8. CAUSES • Increased intra abdominal pressure • Heavy lifting • Chronic cough • BPH • Constipation • Ascites • Pregnancy • Weak abdominal wall • Elderly • Malnutrition • Collagen vascular diseases • Smoking • Obesity

  9. CONGENITAL • Persistant processus vaginalis

  10. CLINICAL FEATURES • Reducible: • Lump • Aches • Non-tender to touch • Increased on standing or increased abd pressure • Irreducible: • Painful enlargement of previously reducible • Can strangulate

  11. Strangulated: • Always painful • Tender • Symp & signs of obstruction,nausea vomiting • May lead to peritonitis n paralytic ileus • Gangrene as early as 5-6 hrs after onset

  12. HASSEL BACH’S TRIANGLE • Medial boundary: Rectus abdominis • Lateral boundary: Inferior epigastric vessels • Inferior boundary: Inguinal ligament • Indirect Inguinal Hernia (out of Hasselbach's Triangle) • Enters Inguinal Canal lateral to inferior epigastrics • Exits Inguinal Canal inferior to inguinal ligament • Direct Inguinal Hernia (within Hasselbach's Triangle) • Breaches posterior inguinal wall • Passes medial to inferior epigastric vessel

  13. DIRECT INGUINAL INDIRECT INGUINAL • Medial to inf epi art • Inside hasselbachs • As a bulge in fascia transversalis • Medial to deep ring • Direction of reduction straight back • On release goes to original position • Elderly • Lateral to inf epi • Outside • Goes from deep ring to sup ring to scrotum • Controled at deep ring • Up & lateral • Down & medial • Young

  14. TYPES OF INDIRECT INGUINAL HERNIA • Bubonocele • Funicular • Scrotal, complete

  15. DIFFERENTIAL DIAGNOSIS • IN MALES: • Vaginal hydrocele • Encysted hydrocele of cord • Spermatocele • Femoral hernia • Incompletely descended testis • Lipoma of cord • IN FEMALES: • Hydrocele of canal of nuck • Femoral hernia

  16. TREATMENT SURGERY

  17. OPEN SURGERY • HERNIOTOMY • Dissection & opening sac • Reducing contents • Transfixing neck • Incising remainder sufficient in infants adolescents and young adults

  18. Direct Hernia Sac Exposed

  19. Hernia Sac Removed

  20. HERNIOTOMY FOLLOWED BY HERNIORAPHY • Repairof defect in internal inguinal ring &transversalis fascia • Reinforcement of posterior wall

  21. Preperitoneal Space Exposed by Opening Transversalis Fascia

  22. TENSION REPAIR • SWELLING • PAIN • IMPROPER HEALING • RECURRENCE • REDUCED PATINT FLEXIBILITY

  23. BASSINIREPAIR • CONJOINT TENDON • INTERNAL OBLIQUE • INGUINAL LIGAMENT

  24. SHOULDICEREPAIR • FASCIA TRANSVERSALIS • INTERNAL OBLIQUE LATERAL • INGUINAL LIGAMENT MEDIAL • CONJOINT ON TOP

  25. LICHENSTEIN REPAIR TENSION FREE REPAIR • LOCAL ANESTHESIA • DIREST VISUALIZATION • MESH USED

  26. TENSION FREE MESH • LOCAL • LESS PAIN • MESH PLACED INSIDE • AND OUTSIDE DEFECT • VELCRO EFFECT

  27. Mesh Anchored at Pubis (near retractor)

  28. Completed Tension-free Repair

  29. MATERIAL • Gortex • Teflon • Decron • Marlex • Prolene • COMPLICATIONS • Bowel perforation • Fistula

  30. COMPLICATIONS OF OPEN SURGERY • INTRAOPERATIVE • Transection spermatic cord • Hemorrhage • Nerve entrapment • Bowel \bladder • Cardiac arrest systemically

  31. POSTOPERATIVE • Seroma • Hematoma • Wound infection • Numbness • Keloid • Scrotal edema • Impotence • Thromboembolism

  32. LAPROSCOPIC REPAIR

  33. LAPROSCOPIC APPROCHES • Transabdominal preperitoneal repair • Peritoneal flap over posterior inguinal area • Totally extra peritoneal approach

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