HERNIAS. Presented by: Al-Fadel M. Alshebani & AbdulMohsin A.Babsail Supervised by: PROF. ABDULLAH ALDHOHAYAN. Introduction Anatomy . Embryological development of the testicles Processus vaginalis Testis descend . Internal spermatic fascia transversalis fascia
Al-Fadel M. Alshebani
PROF. ABDULLAH ALDHOHAYAN
Cremastic muscle internal oblique muscle
Externa spermatic fascia external oblique muscle
Sac: a folding of peritoneum consisting of a mouth, neck, body and fundus.
Body: which varies in size and is not necessarily occupied.
Coverings: derived from layers of the abdominal wall.
Contents: which could be anything from the omentum, intestines, ovary or urinary bladder.
Acquired or congenital
Direct & indirect Inguinal hernia.
Umbilical hernia & paraumbilical hernia.
Rare external Hernias.
The Femoral canal :
A. Umbilical Hernia:
Clolicky pain and/or irreducibilty due to omental adhesions.
Definition:An incisional hernia occurs when the area of weakness is the result of an incompletely healed surgical wound. These can be among the most frustrating and difficult hernias to treat. It can occur at any incision, but tend to occur more commonly along a straight line from the sternum breastbone straight down to the pubis, and are more complex in these regions. Hernias in this area have a high rate of recurrence.
Since many organs or parts of organs can herniate through many orifices, it is very difficult to give an exhaustive list of hernias, with all synonyms and eponyms. But her are Other hernial types and unusual types of visceral hernias:
2. Lumbar Hernias:
A. Petit’s hernia: which occurs in the inferior lumbar triangle.
B. Grynfeltt’s Hernia: which occurs in the superior lumbar triangle and is less common that Petit’s.
3. Obturator Hernia:
Hernias must be examined with the patient standing and in supineAlways examine both groins.
INSPECTION:Visible swelling. (site, size and shape)Visible cough impulse.Easily reducibleReappear on straining, standing or coughing Elucidate Fothergill and Carnet signs.
PALPATION:Examine as a mass and then Palpable cough impulseReduceOcclusion testThree Finger test ( Zimman’s test)
also asses the following:PositionTemperatureTendernessShapeSizeTensionCompositionExpansile cough impulseReducible.
PERCUSSION AND AUSCULTATION:
Most abdominal hernias can be surgically repaired.
Uncomplicated hernias are principally repaired by herniorrhaphy.
aHerniorrhaphy (Hernioplasty) is a surgical procedure for correcting hernia, which can be devided into four techniques:
Groups 1 and 2: open "tension" repair:
in which the edges of the defect are sewn back together without any reinforcement or prosthesis. In the Bassini technique, the conjoint tendon (formed by the distal ends of the transversus abdominis muscle and the internal oblique muscle) is approximated to the inguinal canal and closed. 
Although tension repairs are no longer the standard of care due to the high rate of recurrence of the hernia, long recovery period, and post-operative pain, a few tension repairs are still in use today.
Group 3: open "tension-free" repair:
Almost all repairs done today are open "tension-free" repairs that involve the placement of a synthetic mesh to strengthen the inguinal region.
This operation is called a 'hernioplasty'. The meshes used are typically made from polypropylene or polyester. The operation is typically performed under local anesthesia, and patients go home within a few hours of surgery, often requiring no medication beyond aspirin or acetaminophen.
Recurrence rates are very low - one percent or less, compared with over 10% for a tension repair
Group 4: laparoscopic repair