Inguinal Hernia

Presented by : Dr. Reema Abdullah

 What is hernia?

Abnormal protrusion of viscus or a part of it

through a weak point in the abdominal wall

 What is Inguinal hernia?
An inguinal hernia occurs when tissue, such as part of the intestine, protrudes through a
weak spot in the abdominal muscles in inguinal region. The resulting bulge can be painful,
especially when you cough, bend over or lift a heavy object. However, many hernias do not
cause pain. An inguinal hernia isn't necessarily dangerous.
It is the most common hernia in men and women but
much more common in men.
 Anatomy of inguinal
canal

• The inguinal canal is 4-6 cm long.

• The inguinal canal is a passage in the lower anterior abdominal wall located
just above the inguinal ligament. It starts from the internal inguinal
orifice /deep inguinal ring in the transversalis fascia , extends medially and
inferiorly through the abdominal wall layers and ends in the external
inguinal orifice /surface inguinal ring where the spermatic cord passes from
the aponeurosis of the external oblique muscle.
 Contents of inguinal
canal

• Ilioinguinal nerve ( both sexes )

• Spermatic cord in males
• Spermatic cord constitutes- vas deferens, testicular &
cremastic arteries , pampiniform plexus of veins,
lymphatics
• Genital branch of genitofemoral nerve
• Females – Round ligament is present instead of
spermatic cord.
 Boundaries

• Anterior – Ext. oblique aponeurosis & conjoined muscle laterally.

• Posterior – Fascia transversalis & the conjoined tendon.

• Superiorly (Roof) – conjoined tendon.

• Inferiorly (floor) – inguinal ligament.

Types of Inguinal hernia
Direct and indirect Inguinal hernia
  The congenital inguinal hernia is known as indirect,
oblique or lateral whereas the acquired hernia is called direct
or medial.

An indirect inguinal hernia is one

that occurs as a congenital lesion. It
occurs as a result of the deep inguinal
ring failing to close during
embryogenesis after a testicle has
moved through it. Once bowel or
other abdominal tissue moves into
and enlarges the empty space, a
visible bulge forms and the hernia
becomes clinically evident.
Direct hernias are acquired rather than
congenital and usually occur in people
aged 25 or older. This hernia occurs due
to degeneration and fatty changes in the
inguinal floor or posterior wall in an area
called the Hesselbach triangle.
 Female Inguinal hernia

Male Inguinal hernia

 Clinical types

.
 Risk factors
In infants:
prematurity
male
In adults:
• male
• Obesity
• Constipation
• chronic cough
• Heavy lifting
• Smoking
• Urinary obstructive symptoms
 Diagnosis- Inspection

• Inguinal hernias are best examined with the patient standing.

• Coughing may increase the size of the hernia.
• Site and shape of the hernia:
 those appearing above and medial to the pubic tubercle are
inguinal hernias
 those appearing below and lateral to the pubic tubercle are
femoral hernias
• whether the lump extends down into the scrotum
• any other scrotal swellings
• any swellings on the 'normal' side
• scar from previous surgery or trauma
 Diagnosis- palpation
• Temp. tenderness
• Position and extent
• Get above the swelling(scrotal & inguino scrotal swelling) The root of scrotum is held between the
thumb infront and other fingers behind in an attempt to reach above swelling. Inguinoscrotal Hernia
–cannot get above the swelling
• Consistency(doughy & granular omentum elastic-intestine)
• Relation of the swelling to the testis and sprmatic cord
• Impulse on coughing(Zieman’s technique ): Three finger test
 Diagnosis- Percussion

• The characteristics of hernias depend on their contents:

 bowel is hyper-resonant and has bowel sounds unless it is strangulated

 omentum and fat is dull and does not have bowel sounds
 Systemic examination

• Examine respiratory system

• Per rectal examination
• Abdominal
• Ext genitalia
 Investigations

.
 Managements

.
 Treatment options for inguinal hernia repair
 If it’s small and isn’t a problem doctor may recommend a watch and wait approach

 Growing or painful hernias usually require surgery

Two general types of hernia operations:

 Herniorrhaphy: surgeon makes an incision in your groin and pushes the protruding intestine back into your abdomen then
repairs the weakened or torn muscle by sewing it together .

 Hernioplasty: surgeon inserts a piece of synthetic mesh to cover the entire inguinal area. Often done laparoscopically using
several small incisions instead of one large one. A fiber optic tube with a tiny camera is inserted into your abdomen through one
incision and miniature instruments are inserted through the other incisions. Your surgeon than performs the operation using the
video camera as a guide.
 Open hernia repair
In open hernia repair, the surgeon makes an incision in your groin and pushes the protruding tissue back into your abdomen. The
surgeon then sews the weakened area, often reinforcing it with a synthetic mesh. Then the opening is closed with stitches, staples or
surgical glue.

This procedure is performed under local anesthesia and sedation, or general anesthesia. This is a good option for patients who have a
high risk of complications due to general anesthesia.
Complications
THANK YOU FOR
LISTENING
• https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/treatment-options-
for-inguinal-hernia-repair

• loves-short-practice-of-surgery.pdf

• Up- to date website

• https://en.wikipedia.org/wiki/Inguinal_hernia

REFERENCES