HERNIAS

Riza Pahlevi, dr., M.Si.Med., Sp.B.

SMF BEDAH RSUD MUNTILAN
HERNIA
Hernia is derived from the Latin word for rupture.

A hernia is defined as an abnormal protrusion of an

organ or tissue through a defect in its surrounding
walls.
Primary Abdominal Wall Hernias
Types
of
abdomi
nal wall
hernias
A hernia is reducible when its contents can
be replaced within the surrounding
musculature.

A hernia irreducible or incarcerated when it

cannot be reduced.

A strangulated hernia has compromised

blood supply to its contents, which is a
serious and potentially fatal complication.
Strangulation occurs more often in large hernias
that have small orifices. In this situation, the
small neck of the hernia obstructs arterial blood
flow, venous drainage, or both to the contents of
the hernia sac. Adhesions between the contents
of the hernia and peritoneal lining of the sac can
provide a tethering point that entraps the hernia
contents and predisposes to intestinal
obstruction and strangulation.
 INGUINAL HERNIAS

Inguinal hernias are classified as direct or indirect.

The sac of an indirect inguinal hernia passes from

the internal inguinal ring obliquely toward the
external inguinal ring and ultimately into the
scrotum.

In contrast, the sac of a direct inguinal hernia

protrudes outward and forward and is medial to
the internal inguinal ring and inferior epigastric
vessels.
Anatomy of the Groin
Anterior view of the five major nerves of the
inguinal region.
Incidence

• Men are 25 times more likely to have a

groin hernia than women.

• The female-to-male ratio in femoral and

umbilical hernias, is about 10 : 1 and 2 : 1

• Indirect inguinal and femoral hernias occur

more commonly on the right side.
NYHUS CLASSIFICATION OF GROIN HERNIA
Pathophysiology
 Ideally, the patient should be
Physical Examination examined in a standing position
to increase intra-abdominal
pressure (perform Valsalva’s
maneuver), with the groin and
scrotum fully exposed.

Inspection is performed first, with

the goal of identifying an
abnormal bulge along the groin
or within the scrotum.

Palpation is performed by
advancing the index finger
through the scrotum toward the
external inguinal ring

Digital examination of the inguinal canal.

Differential diagnosis of groin hernia
TREATMENT

• Non operative inguinal hernia treatment

targets pain, pressure, and protrusion of
abdominal contents in the symptomatic

• Operative Surgical repair is the definitive

treatment of inguinal hernias
COMPLICATIONS

• Hernia Recurrence

• Pain

Pain after inguinal hernia repair is

classified into acute or chronic
manifestations of three mechanisms:
nociceptive (somatic), neuropathic, and
visceral pain.
Nociceptive pain is the most common of
the three. Because it is usually a result of
ligamentous or muscular trauma and
inflammation, nociceptive pain is
reproduced with abdominal muscle
contraction. Treatment consists of rest, non
steroidal anti-inflammatory drugs (NSAIDs),
and reassurance, as it resolves
spontaneously in most cases.

Neuropathic pain occurs as a result of

direct nerve damage or entrapment. It may
present early or late, and it manifests as a
localized, sharp, burning or tearing
sensation.
COMPLICATIONS
TYPE OF HERNIAS
FEMORAL HERNIAS
• A femoral hernia occurs through
the femoral canal, which is
bounded superiorly by the
iliopubic tract, inferiorly by
Cooper’s ligament, laterally by
the femoral vein, and medially
by the junction of the iliopubic
tract and Cooper’s ligament
(lacunar ligament). A femoral
hernia produces a mass or
bulge below the inguinal
ligament.
• Obturator Hernia
The obturator canal is formed by the union
of the pubic bone and ischium. This canal
is covered by a membrane pierced at the
medial and superior border by the
obturator nerve and vessels

• The patient can present with evidence of

compression of the obturator nerve, which
causes pain in the anteromedial aspect of
the thigh (Howship-Romberg sign) that is
relieved by thigh flexion.
• Richter’s hernia.
Richter’s hernia, a small portion of the
antimesenteric wall of the intestine is
trapped within the hernia, and
strangulation can occur without the
presence of intestinal obstruction.
• Sliding Hernia
A sliding hernia occurs when an internal
organ comprises a portion of the wall of
the hernia sac.

• A pantaloon-type hernia occurs when

there is an indirect and direct hernia
component.
• Spigelian Hernia
A spigelian hernia occurs through the
spigelian fascia, which is composed of the
aponeurotic layer between the rectus
muscle medially and semilunar line
laterally.
TERIMAKASIH