This document provides information about hernias, including their definition, types, causes, and treatment. The main types of hernias discussed are inguinal hernias (80-90% of cases), femoral hernias (2-5% of cases), and umbilical hernias (more common in developing countries). Inguinal hernias are further classified as direct or indirect. Causes of hernias include defects in abdominal wall tissues, increased intra-abdominal pressure, aging, obesity, and frequent pregnancies. Treatment options mentioned are herniotomy, herniorrhaphy using various suture techniques, and laparoscopic repair.

1. LECTURE FORLECTURE FOR
MBChB VMBChB V
HERNIA

2. Definition:
Protrusion of a viscus or part of it from the
cavity which it is enclosed through an
abnormality or point of weakness in the wall of
the cavity.
 It is the commonest surgical condition
worldwide with a prevalence of 6%.
 Commonest cause of intestinal obstruction in
the developing world ≈ 75%.

3. Types of Hernia
1. Inguinal hernia – 80-90% - conformed in all
communities.
2. Fermoral – 2-5% - More commoner in females
3. Umbilical Hernia – Common after neonatal
sepsis. More in developing countries.
Developmental/genetic factors involved.
Seen more in blacks.
4. Paraumbilical Hernia
5. Epigastric Hernia – 1%
6. Incisional Hernia – 5%
Commonest in poor communities with poor
facilities

4. Cont
7. Spigelian Hernia – Between muscle fibres and
apaneurosis of of transverse abdominis.
8. Lumbar Hernia – At the superior or inferior
lumbar triangle
9. Obturator herniae
10.Sciatic herniae

5. Aetiology:
Two main factors
A – Defect or weakness of the wall of the cavity
(i) Embryological/Anatomical
 Internal inguinal ring
 Femoral ring
 Obturator canal
(ii)Acquired factors
 Ageing – muscle weakness
 Infection of scar or poor surgical technique
 Frequent or multiple pregnancies
 Obesity
 Nerve injury at operation
 Injury to the abdomen

6. B. Increased Intraabdominal pressure.
Chronic cough
Chronic urinary obstruction
Chronic constipation
Heavy manual work
Frequent deliveries
GROIN HERNIAE
Inguinal/Femoral

7. Inguinal Canal:
Contents
 Spermatic cord + vessels
 Ilionguinal nerve
 Genital bb of genitofemoral nerve
In female – Round ligament
It is a passage for gubernaculum testis to the
scrotum in males and to labium majus in the
Females.

8. It is about 4cm long and lies obliquely.
Its boundaries are:
1. Internal Ring: U-shaped and made of
transversalis fascie.
Is about 2.5cm above mid-inguinal point
width of 0.5 – 1cm.
Usually closes when there is increased
abdominal pressure.
2. External Ring:
Is an opening in the ext. oblique
apaneurosis

9. 3. Anterior Wall
External oblique apaneurosis
Internal oblique fibres laterally
4. Posterior Wall
Laterally – Transversalis fascie + aparemosis
of tranversus abdominis
Medially – Conjoint Tendon
5. Floor of the canal – Inguinal Ligament
6. Roof: Arched fibres of internal oblique

10. Hasselbach’s Triangle is formed with:
1.Inferior epigastric vessels laterally
2.Conjoint tendon – medially
3.Inguinal ligament – base
Inguinal hernia – Commonest in both sexes
Males - 95%
Females – 50%
M:F 20:1

11. Direct/Indirect hernia
Indirect – Affects all age groups
- Commonest 20-50 years (60%).
Commonest on right than left 2.1 due
to late descent of testis.
- About 10% are bilateral
Direct hernia – Right is as common as left. 10%
of hernia of those >25 years.

12. Clinical Fxs:
1.Swelling in the groin – Reducible usually
2.Pain – can occur but is rare
Examination:
1.Visble swelling
2.Palpable cough impulse
3.Is reducible
Complete – Enters scrotum
Bubonocele – Limited to canal
Funicular – Above pubic tubercle

13. Complications
1.Irreducibility
2.Strengthening/Gangrene formation
3.Fistula formation
4.Rapture of the sac-enviscesation of hernia
Anatomical Complications
1.Ritchers hernia
2.Sliding hernia
3.Hernia en W

14. Treatment
1.Herniotomy
2.Herniorraphy – Bessinc’s Repair
- Mesh Repair – VIPRO
- Litchensteins procedure
3.Laparoscopy Repair
Complications of Treatment