Post on 18-Apr-2018
transcript
INGUINAL HERNIA FAISALGHANISIDDIQUI
MBBS; FCPS; PGDIP-BIOETHICS; MCPS-HPE
PROFESSOR OF SURGERY J I N N A H S I N D H M E D I C A L U N I V E R S I T Y
PREAMBLE
• ANATOMY OF THE
INGUINAL CANAL
• TYPES OF
INGUINAL HERNIA
• CLINICAL FEATURES OF
INGUINAL HERNIA
• CLINICAL FEATURES OF
INGUINAL HERNIA
• MANAGEMENT
ANATOMY OF THE
INGUINAL CANAL • Boundaries
• Deep inguinal ring
• Superficial inguinal ring
• Support to the deep / superficial rings
• Contents
TYPES OF
INGUINAL HERNIA • Indirect inguinal hernia
• Direct inguinal hernia
• Sliding hernia
• Pantaloon hernia
INDIRECT INGUINAL HERNIA
• Congenital; patent processus vaginalis
• Found in young population
• Oblique
• Lateral to IE vessels
• May extend into the scrotum
DIRECT INGUINAL HERNIA
• Acquired; weakening of posterior wall of inguinal canal
• Elderly patients more commonly effected
• Medical to IE vessels through the Hasselbach’s triangle
• Remains confined to the canal
INGUINAL HERNIA
CLINICAL FEATURES • Intermittent swelling
• Cough impulse
• Reducibility
• Ring occlusion test
INGUINAL HERNIA
MANAGEMENT • No treatment
• Herniotomy
• Open suture repair
• Open mesh repair -Lichtenstein
• Laparoscopic mesh repair (TEP/TAPP)
HERNIOTOMY • In children under 12 years of age
• Involves removal and suture of the sac
• No reinforcement of the posterior wall done
OPEN MESH REPAIR -LICHTENSTEIN • Initial part identical to Bassini’s repair
• Tension-free mesh placed over posterior wall and stitched to the conjoint muscle and inguinal hernia
LAPAROSCOPIC MESH REPAIR • Reduce the contents / sac from within the abdomen
• Place a mesh deep to the abdominal wall
LAPAROSCOPIC MESH REPAIR • Totally extraperitoneal (TEP) approach
• Transabdominal preperitoneal (TAPP) approach