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

ANATOMY OF THE

INGUINAL CANAL • Boundaries

• Deep inguinal ring

• Superficial inguinal ring

• Support to the deep / superficial rings

• Contents

TYPES OF

INGUINAL HERNIA

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

INGUINAL HERNIA

CLINICAL FEATURES • Intermittent swelling

• Cough impulse

• Reducibility

• Ring occlusion test

INGUINAL HERNIA

MANAGEMENT

INGUINAL HERNIA

MANAGEMENT • No treatment

• Herniotomy

• Open suture repair

• Open mesh repair -Lichtenstein

• Laparoscopic mesh repair (TEP/TAPP)

NO TREATMENT Small, asymptomatic, direct hernia

in elderly patients

HERNIOTOMY • In children under 12 years of age

• Involves removal and suture of the sac

• No reinforcement of the posterior wall done

OPEN SUTURE REPAIR • Bassini

• Shouldice

• Darning

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

Laparoscopic Mesh Repair –TAPP Approach

ADVANTAGES OF LAPAROSCOPIC OVER LICHTENSTEIN REPAIR • Less postoperative pain

• Early return to work

• Less incidence of wound complications like infection, bleeding and seroma formation