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Hernia. Tulane University Department of Surgery. What is a Hernia? . Congenital or Acquired defect in the abdominal wall Herniorrhaphy is one of the most commonly performed operations in all of surgery Incidence ~ 1-5%. Physical Exam Characteristics .

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hernia
Hernia

Tulane University Department of Surgery

what is a hernia
What is a Hernia?
  • Congenital or Acquired defect in the abdominal wall
  • Herniorrhaphy is one of the most commonly performed operations in all of surgery
  • Incidence ~ 1-5%
physical exam characteristics
Physical Exam Characteristics
  • Reducible: hernia returns to anatomical location
  • Incarcerated: fixed hernia +/- intestinal obstruction
  • Strangulated: s/s of ischemia and obstruction
abdominal wall anatomy
Abdominal Wall Anatomy
  • 9 Layers
  • Skin
  • Subcutaneous fat
  • Camper’s fascia
  • Scarpa’s fascia
  • External Oblique
  • Internal Oblique
  • Transversus Abdominus
  • Transversalis fascia
  • Peritoneum
types
Types

1. Inguinal

2. Femoral

3. Umbilical

4. Epigastric

5. Sliding

6. Littre’s

7. Internal

8. Obturator

9. Petit’s

10. Gryngelt’s

11. Coopers

12. Pantaloon

13. Richters

14. Incisional

15. Ventral

16. Hiatal

17. Parastomal

18. Etc.

What is the most common Type?

types6
Types

1. Inguinal

2. Femoral

3. Umbilical

4. Epigastric

5. Sliding

6. Littre’s

7. Internal

8. Obturator

9. Petit’s

10. Gryngelt’s

11. Lumbar

12. Pantaloon

13. Richters

14. Incisional

15. Ventral

16. Hiatal

17. Parastomal

18. Etc.

What is the most common Type?

differential diagnosis inguinal hernias
Differential Diagnosis (Inguinal Hernias)
  • Lymphadenopathy
  • Varicocele
  • Undescended testicle
  • Hematoma/Pseudoaneursym
  • Sarcoma
  • Lipoma
contents of spermatic cord
Contents of Spermatic Cord
  • Vas deferans
  • Spermatic vessels
  • Genital branch of gentiofemoral nerve
  • Cremasteric vessels
inguinal repairs
Inguinal Repairs
  • Marcy
  • Bassini
  • McVay
  • Shouldice
  • LICHTENSTEIN – Tension Free
acquired causes
Acquired Causes
  • Increased abdominal pressure
  • Obesity
  • Chronic cough
  • Ascites
  • Pregnancy
hesselbach s triangle
Hesselbach’s Triangle

Indirect (50%) >> Direct (25%)

incisional hernias
Incisional Hernias
  • Up to 11% of pts with previous laparotomy will develop hernia
  • Previous hernia is a risk for development of future hernia
  • Chances of successful closure decrease with each successive repair attempt
paradigm for repairs
Paradigm for Repairs

1900- Silver Filigree Mesh

Stainless Steel Cloth

1940- Tantalum Mesh (metal)

Shift 1

1944- Nylon Mesh

1958- Marlex (Polyethylene)

1962- Prolene (Polypropylene)

1984- Mersilene (Polyester)

Shift 2

1985- Component Separation

Shift 3

- Bioprosthetics

slide18

Component Separation

  • Defined anatomic planes and range of advancement of rectus-internal/transversus muscle block
slide19

Alloderm

  • Acellular Human Dermis
  • Epidermis and all cellular compenents are removed
  • Initially used in burn patients as a scaffolding for STSG
  • Minimal inflammatory response
conclusion
Conclusion
  • Hernias REQUIRESURGERYto prevent further complications (intestinal obstruction and infarction)
    • If reducible----elective
    • If incacerated----semi-elective
    • If strangulated----emergent
questions
Questions?

According to the National Center for Health Statistics, approximately five million Americans have an abdominal hernia, but only a fraction of those seek treatment.

Hernias do not go away and, if left untreated, may worsen over time, causing complications.