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Hernia :
Definition : hernia is the abnormal protrusion of a part or whole of a viscus through the wall of its containing cavity .
What are the parts of hernia sac?
Mouth of the sac : the opening of peritoneal cavity
-Neck of the sac: the constructed part of the sac beyond the mouth
-Body of the sac
-Fundus of the sac: the most distal part of the sac.
Inguinal hernia :
Definition : protrusion of loop of intestine
Before understanding inguinal hernia we need to understand hasselbach’s triangle .
It is located in the posterior wall of the inguinal canal .
The boundaries are :
the lateral side has inferior Epigastric artery .
Medically : lateral border of rectus abdominus.
Base : inguinal ligament
The protrusion can be through inguinal canal or inguinal wall which makes me discuss the very next point that is types of inguinal hernia ,
Now coming to the types :
There are two types :
1.Direct inguinal hernia
- Indirect inguinal hernia
in indirect inguinal hernia the contents pass from deep ring to canal , canal to superficial ring and to the scrotum .
It occurs in male infants and children . The obstruction is common here for narrow neck
Whereas in direct inguinal hernia the protrusion occurs through weak posterior wall of inguinal canal. It occurs in adults. It has wider neck so we can see the obstruction isn’t common here
Tests for hernia :
The most important one is
Deep ring occlusion test :
The deep ring lies 1.25 cm above the mid inguinal point , situated at the midpoint between anterior superior iliac spine and symphysis pubis .
The first bony point felt at the lateral end is the anterior superior iliac spine.
To find symphysis pubis follow the midline from below umbilicus. The first bony point is the symphysis pubis.
Measure the distance between to find the midpoint, the deep ring is 1.25 cm above this point.
The thumb is placed over the deep ring and the patient is asked to cough
No expansile impulse on cough is seen on medial to deep ring, indicating, this is an indirect inguinal hernia.
Treatment (surgical )
1.Hernioplasty Lichtenstein tension free repair : it is dealt with dissecting the sac and invaginations into the abdomen .
Polypropylene mesh is used here . The medial edge of the mesh is sutured to rectus sheath , the superior edge is sutured to conjoined tendon . The lateral edge is split around the cord at deep inguinal ring .
- Herniotomy: it involves dissection of these hernial sac and once the sac is dissected it is opened at the fundus. The content of the sac is reduced, the hernial sac is twisted and ligated at the neck. Reluctant part of the sac is excised. This is all about hernia. Thank you!
