By. Prof Kucher M. from Faculty Surgery Department #1

1. LECTURE 2 ABDOMINAL WALL HERNIAS National O. Bogomolets Medical University Faculty Surgery Department N1 Kyiv 2007 Prof. Kucher M.

2. A h ernia is a hole in the abdominal wall. This hole allows the protrusion of a structure that is supposed to be within the abdomen. The structure that protrudes can be some fat, a loop of intestine, the appendix, an ovary, or part of the bladder. You can think of a hernia like an inner tube of a tire that is protruding out of the outer tread which is worn out. Hernias can occur in men and women of all ages and in children. Some hernias are present at birth. Others develop slowly over a period of months or years.

4. INCIDENCE No peritoneum sac - no hernia:

5. Abdominal wall (ventral) hernias Inguinal hernias are in the groin area. They are most common in men, primarily because of the unsupported space left in the groin after the testicles descend into the scrotum

6. Abdominal wall (ventral) hernias femoral hernias occur at the top of the thigh in the space through which the femoral artery, vein, and nerve pass into the thigh. These hernias occur most often in women

7. Abdominal wall (ventral) hernias Umbilical hernias occur in the umbilicus (belly button). They are usually congenital hernias (present since birth)

8. Abdominal wall (ventral) hernias Incisional hernias occur at the site of previous abdominal surgery

9. Inferior lumbar hernia of Petit Superior lumbar hernia of Grynfellt-Lesshaft

10. The anterior perspecrive

11. The posterior perspecrive

12. TESTIS DESCENDING

13. Congenital inguinal hernia Inguinal hernia: the processus vaginalis has remained open allowing abdominal contents (fluid and loops of bowel) to enter into the scrotum Noncommunicating hydrocele Normal scrotum

14. Can I get above it? hydrocele Congenital hernia

15. the hernia sac exits through the internal inguinal ring and takes an oblique path the hernia sac exits through the external inguinal ring directly Inguinal hernias can be indirect or direct:

16. A sliding hernia is an indirect hernia where the posterior wall of the sac is formed by large bowel (ascending colon on the right, sigmoid/descending colon on the left) or bladder

17. Why do hernias develop? Familial predisposition: connective tissue disorders (altering collagen formation) Hernias commonly develop in an area of weakness including natural spaces and thin tissue, such as the internal inguinal ring and the floor of the inguinal canal. Hernias may develop at these sites or other areas due to aging, injury, an old incision, or a weakness present at birth. Another important factor in the development of hernias is an increase in the intra-abdominal pressure . This could be secondary to chronic constipation and prolonged straining, chronic persistent coughing, lifting heavy objects, pregnancy, obesity, or chronic liver disease.

18. Symptoms & signs Protruding bulge Pain Discomfort Weakness symptoms of Inguinal hernia: Groin lump Groin pain Intestinal blockage reducible swelling ritual of patient cough

19. Physical examination

21. US & Radiology

24. Open Nonprosthetic: Bassini

25. Open Nonprosthetic: Shouldice

26. Open Prosthetic : Lichtenstein

27. М. Кучер Laparoscopic ТАРР

28. М. Кучер ТАРР

29. М. Кучер ТАРР

30. М. Кучер ТАРР

31. М. Кучер ТАРР : m esh fixation (tacking)

32. М. Кучер ТАРР : peritoneum closure

37. М. Кучер if those organs cannot slide easily back into the abdomen,the hernia is said to be irreducible. Irreducible hernias are often painful and can lead to complications Hernia complications

38. М. Кучер if the intestine becomes trapped in the hernia sack it is said to be incarcerated

39. М. Кучер if the neck of the hernia sack actually pinches off the supply of blood to those organs which have become trapped inside, the hernia is said to be strangulated Severe pain Fever Vomiting Gangrene

40. М. Кучер strangulation of antimesenteric portion of the bowel (Richter’s hernia) No signs of obstruction!!! Stragulated hernia Maydl’s hernia

41. М. Кучер strangulated hernia is a medical emergency that requires immediate surgery

43. Mayo umbilical hernia repair

44. Incision hernia