3. Hernia
• Definition
– An abnormal protrusion of an organ or tissue
outside its normal body cavity or restraining
sheath
4. Anatomical structure
Fundus
Covering of
hernia sac
Contents of sac
(usually bowel)
Neck/Mouth
5. Causes of Hernia
• May exploit natural openings(inguinal,femoral and
obturator canals, umbilicus and oesophageal hiatus) or
weak areas caused by stretching, surgical incision or
laparotomy
• Any condition that increases the pressure of the abdominal
cavity may contribute to the formation or worsening of a
hernia.
– Obesity
– Heavy lifting
– Coughing
– Straining during a bowel movement or urination
– Chronic ling disease
– Fluid in the abdominal cavity
– Hereditary
6. Classification of abdominal hernia
Inguinal hernia/Groin hernia
Direct inguinal hernia
Indirect inguinal hernia
Femoral hernia
Ventral hernia
Epigastric hernia
Umbilical hernia
Para-umbilical hernia
Spigelian hernia
Incisional hernia
Other rare and specific interparietal hernia
7.
8. Sign and symptoms
• The signs and symptoms of a hernia can range from
noticing a painless lump to the painful, tender,
swollen protrusion of tissue that you are unable to
push back into the abdomen—possibly a
strangulated hernia.
– Reducible hernia
– Irreducible hernia
– Obstructed hernia
– Strangulated hernia
– Inflammed hernia
9. Reducible hernia
– Asymptomatic reducible hernia
• New lump and the groin or other abdominal wall area
• May ache but is not tender when touched.
• Sometimes pain precedes the discovery of the lump.
• Lump increases in size when standing or when abdominal pressure
is increased (such as coughing)
• May be reduced (pushed back into the abdomen) unless very large
10. Irreducible hernia
– Irreducible hernia
• Usually painful enlargement of a previous hernia that
cannot be returned into the abdominal cavity on its
own or when you push it
• Some may be long term without pain
• Can lead to strangulation
• Signs and symptoms of bowel obstruction may occur,
such as nausea and vomiting
11. Strangulated hernia
– Strangulated hernia
• Irreducible hernia where the entrapped intestine has
its blood supply cut off
• Pain always present followed quickly by tenderness and
sometimes symptoms of bowel obstruction (nausea
and vomiting)
• You may appear ill with or without fever
• Surgical emergency
• All strangulated hernias are irreducible (but all
irreducible hernias are not strangulated)
16. Incisional hernia
• One that occurs through the wound of a
previous operation
• Same features as a hernia that is caused by
non-surgical injury to the abdominal wall
• 1% of transparietal abdominal incisions are
followed by a hernia
17. Aetiology
• A postoperative complication,can be
considered in terms of three factor
– Preoperative factors
– Operative factors
– Postoperative factors
18. Preoperative factors
• Age: older usually need more time to heal
• Malnutrition
• Sepsis: worsen
• Uraemia: inhibit fibroblast division
• Jaundice: impedes collagen maturation
• Obesity
• Diabetes mellitus
• Steroids
• Peritonitis
19. Operative factors
Type of incisions
vertical are more prone to hernia than transverse
Technique and materials
Tension in the closure decrease the blood supply
in wound
Loosen knots
Closure using rapidly absorbable suture materials
Type of operation
Operations involve bowel or urinary tract are
more likely to develop wound infection
Drain tube
20. Postoperative factors
• Wound infection:
– Same important with the wrong choice of suture
material
– Enzyme destruction of healing tissues
– Inflammatory swelling raises tissue tension and impedes
blood supply
– 5-20% of wound infections result in a hernia
• Abdominal distension
– Postoperative ileus increase the tension on a wound
– Stitches may cut out
• Coughing:generates wound tension
21. Signs and symptoms
• A bulge in the scar
• As the hernia enlarges and loculates, symptoms of
subacute I/O are common
• Overlying skin:thin and atrophic,eventually ulcer and
rupture
• Strangulation is a surgical emergency
• P/E:
– Usually reducible
– Hernia with a cough impulse at the site of an old scar
– When the patient lies flat, hernias deceptively small,any
manoeuvre that raise intra-abdominal pressure
produces the hernia in all its glory
22. Management
Even small symptomatic hernias should be repaired early
Prolonged observation simply increase the difficulties of
subsequent repair and hazardous
Surgical technique:same as for para-umbilical hernia
Exicision of the sac after reduction of its contents
Insertion of overlapping sutures into the rectus sheath
23. Spigelian hernia
• Rare but clinically important, less than 1% of total
• An interparietal hernia in the line of the linea
semilunaris(the lateral margin of the rectus sheath)
• Usually at the level of the arcuate line:due to all
aponeurotic layers are reflected anterior to the rectus
muscle
• The hernial sac emerges and enlarges like a mushroom
deep to the external oblique
24. S&S
Symptoms
Local pain that is worse on straining
Lumps
Non-specific lower quadrant discomfort which needs to be
investigated
Features of obstruction or strangulation
Signs:
Tenderness at the site of the hernial orifice
Lump which may be difficult or even impossible to feel
25. Management
• Abdominal USG/CT:useful in the demonstration of these
hernias
• Repair:A simple matter of excising the sac and closing the
defect/Laparoscopic repairs
