Hernias

Dr Omar Mansour

FRCS FRCSI UEMS MRCSI MSc MB

BCh BAO Arab Brd Jord Brd

• Definitions

• Groin

• Incidence

• Indications for surgery

• Complications

• Types of surgery

• Know your anatomy, AGAIN!

Inguinal hernias

1. Inguinal ligament

2. Muscular part of

transversus abdominus

3. Tranversus abdominus

aponeurosis

4. Muscular part of internal

oblique

5. Internal oblique

aponeurosis

6. Transversalis fascia

7. Cremasteric fascia over

spermatic cord

8. Pubic tubercle

Umbilical hernias

Decision to operate

• Careful examination

– Erect and supine

– Direct/indirect or pantaloon?

– Is there a cough impulse…if so hernia or

saphena varix? If not, is it strangulated?

– Don’t forget the scrotum, can you get above it?

Which Procedure

• Open/ Laparoscopic

• Darn, Shouldice or

Lichtenstein (mesh)?

• Local/general/regional

anaesthesia?

Local Anaesthesia

• Compliant patient

– Adequate monitoring

– Resusitation available if adverse reaction

• Sufficient volume required

• 100mls 0.5% lignocaine +1/100,000 adrenaline

– 20mls along incision line

– 25mls deep (superficial to inguinal canal)

– 5-10mls ilioinguinal block

– 50mls during procedure as required

Open Hernia Repair

• Open inguinal canal

• Protect the ilioinguinal nerve

• Isolate the cord

• Identify and reduce/resect hernia sac

• Repair the defect