05/10/20 Dr. Sreedhar.

M 1
• Protrusion of a viscus or a part of viscus
through an abnormal opening in the walls of
its containing cavity.

05/10/20 Dr. Sreedhar. M 2

1. Inguinal- 70-75%
2. Para-umbilical- 5%
3. Umbilical- 5%
4. Epigastric.
5. Femoral- 15-20%.

05/10/20 Dr. Sreedhar. M 3

 1. Incisional.
2. Spegelian.
3. Divarication of recti.
4. Obturator.
5. Lumbar.

05/10/20 Dr. Sreedhar. M 4

1. Conditions increasing intra-abdominal
pressure- Chronic cough, BPH, constipation.
2. Intra abdominal tumors.
3. Smoking.
4. Obesity.
5. Congenital weakness.
6. Previous surgeries.
7. Repeated pregnancies.
05/10/20 Dr. Sreedhar. M 5
• The sac- Mouth, Neck, Body & fundus.
• The covering.
• Contents.

05/10/20 Dr. Sreedhar. M 6

1. Omentocele.
2. Enterocele.
3. Richter’s hernia.
4. Sliding hernia.
5. Litter’s hernia.
6. Maydl’s hernia.

05/10/20 Dr. Sreedhar. M 7

1. Reducible.
2. Irreducible.
3. Obstructed.
4. Strangulated.
5. Inflamed.
6. Incarcerated.

05/10/20 Dr. Sreedhar. M 8

 • Anatomy-
– Superficial inguinal ring.
– Deep inguinal ring.
– Inguinal canal.
– Hesselbac’s triangle.
05/10/20 Dr. Sreedhar. M 9
• In Infants it is absent.
• 3.75 cm. long.
• Contents- in females it contains round
ligament of uterus.

05/10/20 Dr. Sreedhar. M 10

Anatomy- Contents of inguinal canal-
Spermatic cord.
Ilio-inguinal nerve.
05/10/20
Genital branch of genitofemoral nerve.
Dr. Sreedhar. M 11
• Direct hernia.
• Indirect hernia.
– Bubonocele.
– Funicular.
– Complete.
• Pantaloons'
hernia.
05/10/20 Dr. Sreedhar. M 12
• History.
• Examination.
• Indirect can be congenital, common in young.
• Differential diagnosis-
– Vaginal hydrocele.
– Femoral hernia.
– Undescended testis.
– Lipoma of cord.

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• Surgery only.
– Herniotomy.
– Herniorraphy.
– Hernioplasty.
– Laparoscopic surgery.
• Treatment of complicated inguinal hernia.

05/10/20 Dr. Sreedhar. M 14

• Herniation through femoral canal.
• Femoral canal is medial most compartment of
femoral sheath.
• Canal extends from femoral ring above to
saphenous opening below.
• Femoral canal is 1.25 cm. long.
• Common in multiparous women, due to stretching
of pelvic ligaments.
• Incidence of complications are very high.
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• Ant.- inguinal ligament.
• Post.- iliopecteneal ligament.
• Med.- lacunar ligament.
• Lat. By thin septum separating it from femoral
vein.

05/10/20 Dr. Sreedhar. M 16

• lockwood’s operation- below inguinal
ligament approach.
• Mcevedy operation- both above & below
inguinal ligament with vertical incision.
• Lotheissen’s operation- through inguinal
canal.
• Suturing conjoined tendon to ileo-pecteneal
fascia.

05/10/20 Dr. Sreedhar. M 17