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Anatomy and Physiology

‡
small intestine
‡
internal inguinal ring
‡
external inguinal ring
‡
pubic bone spermatic cord
‡
testes
‡
penis

PAT HOPHYSIOLOGY
‡
The fascia is not of the same strength in all areas of the abdominal wall. One of the weaker places is in
the
groin, or inguinal, area. Due to its relative weakness, this location is particularly prone to hernias.
‡
Indirect inguinal hernias usually occur because of a persistent process vaginalis. As the hernia emerges
through the deep internal ring, it carries with it fascial linings of the tissue it transverses. The hernia
courses
along the inguinal canal lateral to the epigastric arteries and emerges through the external ring slightly
lateral
to the pubic tubercle. Contents of this hernia then follow the tract of the spermatic cord down into the
scrotal
sac in men, or follows the round ligament in females
Pathophysiology
ƕ
Hernia = protrusion of organ or tissue out of the body cavity in which it normally lies, usu. due to a
fascial defect
ƕ Ppt factors
Ĺ Abd pressure
‡
Straining
‡
Obesity
‡
Pregnancy
‡
Ascites
‡
Coughing/COPD
ƒ
Abnormal congenital anatomic route
‡
Patent processus vaginalis
ƕ
Indirect inguinal hernia
ƒ
Hernia thru internal ring of inguinal canal, toward external ring
ƒ
Due to patent processus vaginalis (congenital)
ƒ
May enter scrotum if complete
ƒ
Think of hernia sac traveling indirectly thru abdominal wall via inguinal canal
Management
ƕ
Medical
ƒ
Truss
‡
Fist-sized ball of leather, rubber or fabric positioned over hernia and fastened w/ straps/belts.
‡
Doesn¶t solve problem
ƕ
Increased scarring
ƕ
Increased incarceration risk
‡
For poor surgical candidates
ƕ
Surgical repair
ƒ
Indirect hernia
‡
Reduce abdominal contents back into abdomen
‡
Obliterate processus vaginalis high against the abdominal wall
‡
Reform abdominal ring around spermatic cord and onto Cooper¶s ligament and anterior femoral
sheath

Hernia Surgery
It's a lump in the groin that seems innocuous at first. An inguinal hernia happens when the intestines or
other tissues protrude through a hole in the abdominal wall. It's the most common type of hernia and
can sometimes become painful enough to interfere with normal activities such as walking or lifting
objects. Left untreated, this hernia has the potential to cause serious problems.
For this reason, doctors usually recommend either open surgery or laparoscopic surgery to push the
protruding tissue back and patch the hole. The minimally invasive - or laparoscopic - procedure has
been gaining popularity as an alternative to open surgery, said Dr. Matthew Dolich, who performs both
types of hernia repair at UCI Medical Center in Orange. Laparoscopic hernia repair involves using thin
instruments and several incisions less than half an inch long. It appeals to somepatients because it often
involves less pain and quicker recovery.

á

 
Reducible:
Intestines protrude out of
the abdominal cavity but
can be pushed back.
Incarcerated:
Protruding intestine or tissue is
trapped and can't be pushed back.
Sometimes, this needs immediate
surgery.
Strangulated:
Protruding intestine is trapped and blood supply
is cut off. This can result in gangrene and death
and is a medical emergency. This needs
immediate surgery.
Anatomy
‡ Inguinal canal lies between the superficial and deep inguinal rings
‡ Deep ring lies deep to the mid-inguinal point
‡ Mid-inguinal point is half way between symphysis pubis and anterior superior iliac spine
‡ Not the midpoint of the inguinal ligament
‡ n men it contains vas deferens and testicular artery and veins
‡ In women it contains the round ligament
‡ Anterior border is the external oblique aponeurosis
‡ Posterior border is the transversalis fascia
‡ Inferior border is the inguinal ligament
‡ Superior border is the conjoint tendon - the lower fibres of internal oblique and transversus abdominis
‡ Indirect hernias arise lateral to the inferior epigastric vessels
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