Royal Army of Oman

Armed Forces Medical Services

Armed Forces Medical Services School
General Surgical Procedures Course 2021-2022

Abdominal Wall Hernia

Masoud Al Saifi, MD
OMSB general surgery resident
 Objectives:

1. Define hernia and its causes

2. Describe and incarcerated hernia.
3. Identify the principle involved in hernia repair with biosynthetic mesh.
4. Identify the position, incision, draping, instruments, and possible extras used in open repair of an indirect inguinal hernia.
5. Recognize the different between direct and indirect inguinal hernia.
6. Recognize the technical points/steps of the open repair of an indirect inguinal hernia procedure.
7. Identify the position, incision, draping, instruments, and possible extras used in laparoscopic repair of direct inguinal hernia.
8. Recognize the technical points/steps of the laparoscopic repair of direct inguinal hernia procedure.
9. Define incisional hernia.
10. Identify the position, incision, draping, instruments, and possible extras used in open and laparoscopic repair of incisional
hernia.
11. Recognize the technical points/steps of the open and laparoscopic repair of incisional hernia procedure.
12. Identify the position, incision, draping, instruments, and possible extras used in open and laparoscopic repair of umbilical
hernia.
13. Recognize the technical points/steps of the open and laparoscopic repair of umbilical hernia procedure.
Definition of
Hernia Protrusion of viscus (or part
of viscus) outside its cavity.
Causes & Risk factors

Increase of intra-abdominal pressure:

• Obesity
• Chronic cough
• Pregnancy
• Constipation
• Straining on urination.
• Heavy lifting
• Smoking

Congenital abnormality (e.g. patent processes vaginalis)

 Types of
abdominal wall
hernia
Inguinal (Most common).

Femoral.

Umbilical/ Para-umbilical.

Incisional.

Epigastric.
Direct vs Indirect inguinal Hernia

• Direct inguinal hernia: A hernia that results from weakness in

the inguinal floor.

• Indirect inguinal hernia (More common): A hernia that

protrudes into the spermatic cord. Usually due to a congenital
defect in the abdominal wall.
Incisional Hernia

• Protrusion of abdominal
tissue through one or more
abdominal layers.

• This results from a previous

abdominal incision that
failed to heal completely or
later broke down because of
obesity, infection, or disease.
 Complications of Hernia

• Normally is reducible.
Complications

Irreducible Obstructed
(incarcerated) Blood supply is Strangulated
No obstruction good, but Blood supply is
and good blood patient has compromised.
supply. bowel
obstruction.
Irreducible Obstructed Strangulated
Treatment

Open or laparoscopic.

Mesh or without mesh.

• most repairs now done using tension free techniques with
mesh.
Pubic Sym
physis

ASIS

Open repair
Same for direct/indirect
Mesh repair
Laparoscopic repair
TAPP & TEP
TAPP
Quiz
What is the most common hernia?
a. Femoral hernia.
b. Direct inguinal hernia.
c. Indirect Inguinal hernia.
d. Umbilical hernia.
Most extreme complication of
hernia is ….
a. Reducible.
b. Irreducible.
c. Obstructed.
d. Strangulated..
Most hernia repair done:
a. With mesh.
b. Without mesh.
c. laparoscopic.
d. Open.
All of these are risk factors for
hernia except …
a. Pregnancy.
b. Obesity.
c. Spicy food.
d. constipation.
Hernia that occur due to failure of
scar healing is called
a. Epigastric.
b. Spigelian.
c. Incisional.
d. Umbilical.
Thank you