Hernia
Hernia
Hernia
Etiology:
There are 2 main etiological factors that are required
for the development of a hernia:
1) Weakness
2) Excessive intra-abdominal pressure
In turn, this weakness could be due to:
I. Site:
External hernia vs Internal hernia
II. According to Complexity:
• Reducibility
• Cough impulse
• Tenderness
• Overlying skin colour changes
• Multiple defects/contralateral side
• Signs of previous repair
• Scrotal content for groin hernia
• Associated pathology
Investigations:
Treatment:
There are two main types of inguinal hernias; direct (aka medial)
and indirect (aka lateral) inguinal hernias, and are best explained
by the following table:
Indirect inguinal hernia Direct inguinal hernia
Age Mostly pediatrics but any age Mostly elderly, never in children
group could be affected
Sex Males are more affected Only males
Passage Passes through inguinal canal Does not pass through inguinal canal.
Descent Forwards, medially and downwards. Directly forwards. Cannot descend into
Can descend into scrotum. scrotum.
Borders:
Relation to Above and medial to pubic Below and lateral to pubic tubercle
pubic tubercle tubercle
Treatment:
SURGERY IS MANDATORY! It is wise to treat such cases with
some urgency. There are three open approaches, in addition to a
laparoscopic approach:
• Low approach (Lockwood)
• The inguinal approach (Lotheissen)
• High approach (McEvedy)
• Laparoscopic approach
Ventral
Hernias
Ventral hernias:
This term refers to hernias of the anterior abdominal wall. Inguinal and
femoral hernias are not included even though they are ventral. Lumbar
hernia is included despite being dorsolateral.
• Umbilical
• Paraumbilical
• Epigastric
• Incisional
• Spigelian
• Parastomal
• Lumbar
• Traumatic
Umbilical hernia:
For defects < 2 cm: The sac is excised and the edges of the rectus
sheath are overlapped above and below the hernia (Mayo's
operation).
Traumatic hernia:
These hernias arise through defects caused by injury. They can
be classified into three types:
Diagnosis: The key to the aetiology is in the history and the non-
anatomic location of the hernia.
Littre hernia:
a hernia that contains mickel’s diverticulum.
Pantaloon hernia:
presence of both direct and indirect inguinal hernias in the same
patient.
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