HERNIAS

BY
DR.OKEDARE. A..O.
CONSULTANT FAMILY PHSICIAN
OUTLINE

 INTRODUCTIONS
 TYPES OF HERNIAS
 ANATOMY OF COMMON HERNIAS
 SURGICAL TECHINIQUES
 THE ROLE OF THE FAMILY PHYSICIAN
 CONLUSIONS
INTRODUCTIONS

 Definitions
 A Hernia-is a protrusion of an abdominal
viscus through an abnormal opening.
 Hernias could be –External or Internal
 Pathological Anatomy: A hernia consist of
three parts, the sac, the content of the sac,
and the covering of the sac.
EPIDEMOLOGY

 Hernias are the most common surgical

diagnosis in any Surgical unit.
 Repairs of hernias also constitute the
commonest operation that will be performed
by any General surgeon/surgically inclined
Family Physician.
EPIDEMOLOGY

 IN 2007
 1,052 MAJOR SURGERIES WERE
CARRIED OUT IN OCH,IBADAN.
 652(62.0%) CEASEREAN SECTIONS
 66(6.3%) HERNIAS WERE REPAIRED.
 48(4.6%) APPENDICECTOMIES
 52(4.9%) ECTOPICS
 234(22.2%) OTHERS
EPIDEMOLOGY

 77.8% of the surgical procedures were within

the competence of a Family Physician.
 Hernia repair is a must know surgical
technique for a Family Physician because of
its prevalence and life saving importance.
 Minimum of 70% of major surgeries in a
secondary centre is within your competence.
TYPES OF HERNIAS

 External:
 Epigastric,Para-
umbilical,Umbilical,Spigelian,Incisional,
Inguinal
Femoral,Obturator,Lumbar(superior,Inferior),
Gluteal,Sciatic
 Internal: Diaphragmatic
CLASSIFICATIONS

 Reducible
 Irreducible
 Obstructed
 Strangulated
 Inflamed
ANATOMY OF THE INGUINAL HERNIA

 Inguinal ligament
 Internal inguinal Ring
 External inguinal Ring
 Inguinal Canal
 Contents-Male: spermatic cord and ilio-
inguinal nerve.
-Female: round ligament and ilio-
inguinal nerve.
ANATOMYOF THE INGUINAL HERNIA

 Indirect inguinal hernia:

 passes through the internal ring, along the
canal then through the external ring and
descends into the scrotum. It is lateral to the
epigastric vessels
ANATOMY INGUINAL HERNIA

 Direct inguinal hernia:

 Pushes through the posterior wall of the
inguinal canal, lying medial to the inferior
epigastric vessels.
FEMORAL HERNIA

 Passes through the femoral canal.

 Boundaries of the femoral canal:

 Anteriorly-Inguinal ligament
 Medially- Gimbernat’s ligament,
thepectetineal part of the inguinal ligament
FEMORAL HERNIA

 Laterally-the femoral vein (remember VAN

arrangement.)
 Posterioly-Pectineal ligament of Astley
Cooper-
 Content-Plug of fat and the node of Femoral
canal or Cloquet’s gland.
SURGICAL TECHNIQUES

 EMERGENCY REPAIRS
 ELECTIVE REPAIRS
 AS IN ALL SURGERIES:
1. PRE-OP PREPERATION-
PCV,URINALYSIS,RVS,PSYCOLOGICAL.
2. ANAESTHESIA-Pre-medication: Atropine
-Anesthesia-Local
Infilrration,Spinal,or General Anesthesia
SURGICAL TECHNIQUES

3 INCISION
4 IDENTIFICATION OF THE SAC
5 REPAIRS-Inguinal Hernia: Bassini
-Femoral: Mac-vay
-Umbilical: Mayo’s Operation-
overlapping the edges.
6.POST –OPERATIVE CARE.
EMERGENCY SURGERY

 EMERGENCY SURGERY
 FOR-OBSRUCTED/STRANGULATED
HERNIA.
 Admit patient.
 Intravenous Fluid to replace loss, and
maintenance through surgery and post-op
period.
 N-G tube to decompress
EMERGENCY SURGERY CONT’D

 Urethral catheter –for fluid input and output

monitoring.
 Cold Compress
 PCV,URINALYSIS,E&U and Creatinine
 Analgesics
 Antibiotics
EMERGENCY SURGERY CONT’D

 AT SURGERY: Check the content of the sac

if there is gangrenous intestine –do re-section
and anastomosis
 POST-OPERATIVE CARE

-Sustain Fluids maintenance

-Antibiotics
-Analgesics
THE ROLE OF THE FAMILY
PHYSICIAN

 DIAGNOSIS
 PARTICIPATION IN MASS REPAIR OF
HERNIAS
 CARRY OUT OTHER OPERATIVE
PROCEDURE IN PRIMARY AND
SECONDARY HEALTH CARE SET-UP.
CONLUSION

 The anatomy, epidemiology, repair technique

of common hernias has been described.
 The central role of the Family Physician in
carrying out its repair has been emphasized.