Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Surgery 27 Hernia Femoral Hernia Epigastric Hernia PPT-Powerpoint Presentations and lecture notes
Hernia - Femoral hernia, Epigastric
hernia, Paraumbilical hernia,
Incisional hernia
Types of Abdominal Hernia
? Epigastric
? paraumbilical
? Umbilical
? lumbar
? Spigelian
? femoral
? inguinal
The Basic Feature Of Al Hernias
? Occur at a weak spot .
? Reduce on lying down ,or with direct pressure.
? Have an expansile cough impulse
A hernia consist of 3 parts:
1.Sac:
consist of a diverticulum of
peritoneum.
2.Contents:
Omentum, small or large intestine,
urinary bladder, Omentum, ovaries
malignant nodules or ascetic fluid.
3.Coverings:
derived from the layers of abdominal
wall.
Complications Of Hernias
? Irreducible
the hernia contents cannot be manipulated back into the abdominal
cavity.
? Incarcerated
the contents of the sac are literally inpresiond in the sac of Hernia.
? Obstruction
the loop of the bowel become non functioning with normal blood
supply .
? Strangulated
cut off the blood supply to the content sac (tender).
Femoral Hernia
Femoral Canal
? The major feature of the femoral canal is the femoral
sheath.
? This sheath is a condensation of the deep fascia (fascia
lata) of the thigh and contains, from lateral to medial,
the femoral artery, femoral vein, and femoral canal.
? The femoral canal is a space medial to the vein that
al ows for venous expansion and contains a lymph
node (node of Cloquet).
? Other features of the femoral triangle include the
femoral nerve, which lies lateral to the sheath
Femoral Hernia
Femoral hernia
Age: uncommon in children , most common in old age
female .
Sex: women > men (but still commonest hernia in
women the inguinal hernia )
Discomfort and pain
Swelling in the groin
Femoral hernia is more likely to be strangulated than
the inguinal hernia
Narrow neck High risk for strangulation
Multiplicity: often bilateral
Femoral hernia versus inguinal hernia
Inguinal hernia
Femoral hernia
1- more common in male
1- more common in females
2- pass through the inguinal canal
2- pass through the femoral canal
3- neck of the sac is above and medial
3- neck of the sac is below and lateral
the pubic tubercle
the pubic tubercle
4- less common to be strangulated
4- more common to be strangulated
5- can be treated without surgery
5- must be treated surgical y
6- the two diagnostic signs of hernia +
6- the two diagnostic signs of hernia -
7- the sac mainly contain ; bowel
7- the sac mainly contains ; omentum
Femoral hernia repair
Femoral hernias should be repaired very soon after
the diagnosis has been made because of the high risk
of strangulation
There is no place for a truss for a femoral hernia
Different approaches :
Open VS Laparoscopic
Open surgery
Three approaches have been described for open
surgery :
? Infra-inguinal approach (Lookwood)
? Supra-inguinal approach ( McEvedy)
? Trans-inguinal approach ( Lotheissen)
Each technique has the principle of dissection of
the sac with reduction of its contents, followed
by ligation of the sac and closure between the
inguinal and pectineal ligaments.
Epigastric Hernia
? It occurs through the linea alba midway between the
xiphisternum & the umbilicus
? It is a protrusion of extraperitonial fat from the site of
entry of a small blood vessel through the linea alba
(fatty Hernia of linea alba)
? It is usually small in size, it may drag a pouch of
peritoneum to form a true hernia
? The neck is usually too small to allow a hollow
viscous to enter it, consequently the sac is empty or
it contains small part of omentum (not true hernia )
? It is probably as a result of sudden strain that tears
the interlacing fibers of linea alba
? Clinically; The patient is usually a manual worker, 30-
50y in age, symptom less, incidentally discovered
during routine exam
? Pain & tenderness is due to strangulated fat.
? Referred pain & dyspepsia
? Treatment: Excision & repair of defect.
Epigastric Hernia
Umbilical Hernia
? True umbilical Common in children
? Intestinal obstruction extremely rare
? Surgical repair if persisted after 3rd birthday
? Site: in the center of the umbilicus
? Size and shape: size can vary from vary small to very
large. Shape is usually hemispherical.
? Composition: contain bowel, resonant to percussion
? They reduce spontaneously when the child lies down
? Reducibility: easy
? Cough impulse: invariably present
Acquired umbilical hernia
Hernia through the umbilical scar , so it is a true
umbilical hernia.
Not common and is usually secondary to increase intra
abdominal pressure.
The most common causes
pregnancy
ascites
ovarian cyst
fibroids
bowel distension
Para-umbilical hernia
? Para umbilical usually middle age women obese or
multiparous
? It is a protrusion through the linea alba just above or the
umbilicus. As it enlarges it sags downward and can attain a
large dimensions
? The neck of the sac is narrow as compared with the size of
the sac & it's contents ( omentum, small intestine or part of
the colon). Usually loculated due to adhesions.
? Clinical y; more common in women, obese, multiparous & 35
-50y of age.
? It becomes irreducible due to adhesions & strang-ulation
may occur.
? Pain colicky or dragging.
? The skin over it becomes reddened, smooth & may become
excoriated.
? Treated by division of adhesions. & repair of defect "Mayo's
repair"
Incisional Hernia
? Protrusion through surgical wound
? Occur after 3-5% of abdominal operation
? Causes
1. Midline ,vertical incision
2. Poor technique
3. Wound or chest infection
4. Obesity
Strangulation is rare but repair is advisable
Incisional hernia
Prevention of Incisional Hernia
? Continuous Closure with Running Suture
? Monofilament slowly absorbable suture (PDS)
#1 or 2
? Suture: Wound Length < 4:1
Summary
? Hernias are common, morbid, and costly
? Best chance of success is mesh repair : uncontaminated field
? Laparoscopic vs Open stil debated
? What can't be cured must be endured
This post was last modified on 08 April 2022