Strangulated and other hernias

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STRANGULATED HERNIA

An   emergency  operation  is  undertaken  for  a   hernia   with

strangulated  content  when  gangrene  may  have  developed,  all

gangrenous tissue must be resected.  When strangulated intestinal

is  present;  this requires an anastomosis between  normal  bowel

sections proximal and distal to the necrotic area.

Other Hernia

The so called lumber hernias develop through the lateral abdominal

wall  and  occur in the scar of the incision used to  expose  the

kidney.

A Petit's triangle hernia is another lumbar hernia bounded by the

external  obliquue anteriorly iliac crest inferiorly,  latissimis

dorsi  posteriorily. 

e.

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Para Umbilical Hernia Mayo repair

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. PARAUMBILICUL HERNIAS

Paraumbilicul  hernias  occur later in adult life  especially  in

females  at  or  around  the  umbilicus  usually  after  multiple

pregnancies.   It  may  be  due to a minor  defect  left  at  the

umbilicus in the  process of repair in infancy.

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MAYO'S OPERATION

The  incision is transverse, the sac neck is identified, the  sac

opened near this site.   The content reduced.   The lower flap of

the  rectus sheath is brought under the upper flap of the  rectus

sheath  and  is  sutured with matress sutured.   The  upper  flap

overlaps the lower flap and sutured in place.

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GROIN HERNIA REPAIR

INGUINAL HERNIA Fig. 24.10

Indirect Hernia  Fig 24.10a

Ingural incision half an inch above and paratel to the inguinal ligament

Inguinal Hernia

Cut skin and subcutaneous tissue

Open external oblique aponeurosis in the same line

Identify the cord and free it by blunt dissection.

Open the cremaster muscle the indirect sac is identified and opened finger introduced to enter the neck and peritoneal cavity.

Sac separated from cord structure by blunt and sharp dissection

The contents reduced sac twisted and ligated as high as possible. Sac excised.

Repair defect in transverselis fashia

If the posterior wall is weak a Bassini repair of the posterior wall is done by plication

The conjoint tendon can also be sutured to the inguinal ligament

External oblique is closed

DIRECT INGUINAL HERNIA

This  hernia is due to a diffuse bulge of the posterior  wall  of

the  inguinal  canal  and it is this wall that  needs repair  and

reinforcement with mesh after the sac has been excised.

Direct Hernia

The incision is the same as for indirect hernia

The incision is depended to cut subcutaneous tissue

External oblique identified and cut along the line of incision

The inguinal canal is now open

Identify the cord and free it by blunt dissection

The direct hernia bulge will be seen behind find the cord

Placation of the tranversalis muscle ligament

A Bassini repair of the posterior wall

Conjoint tendon is sutured to the inguinal ligament

In some cases a marlex mesh is sutured behind the cord to reinforce the posterior wall

The external oblique and skin are closed.

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