Direct and Indirect inguinal Hernia Dr. Ahmad Uzair Qureshi FCPS ( SURGERY) / MCPS ( SURGERY) MRCS ( ENGLAND) / Dip Med Edu (Cardiff) Colorectal Fellow Yonsei University, South Korea Assistant Professor of Surgery, King Edward Medical University, Lahore
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Direct and Indirect inguinal Hernia
Dr. Ahmad Uzair QureshiFCPS ( SURGERY) / MCPS ( SURGERY)
MRCS ( ENGLAND) / Dip Med Edu (Cardiff) Colorectal Fellow Yonsei University, South Korea
Assistant Professor of Surgery, King Edward Medical University, Lahore
Objectives• The students will be able to
• Define hernia• Different sites and types of hernia• Enlist clinical features of groin hernia• Enumerate differences in direct and indirect hernia• Describe contents of hernia sac and their origin• Enlist complications which may arise from hernia• Describe the steps of open Hernia repair
ABDOMINAL REGIONS WHERE
HERNIAS OCCUR
What is a Hernia?It is an abnormal protrusion of a viscus or part of a viscus through
a potential weak space of its containing cavity.
CLINICAL FEATURES
Lump at an appropriate anatomical site
Increases in size on coughing or straining.
It reduces in size or disappears when relaxed or supine
position.
Examination may show it to have a cough impulse and to be
reducible
Rt. INDIRECT ING. HERNIA
FACTORS PREVENTING HERNIATION
1- Oblique coarse of the inguinal canal .2- Contraction of conjoint tendon during coughing or straining (shutter mechanism) .3- Contraction of cremasteric muscle : Plugging of inguinal canal
Groin hernia• Inguinal• Femoral• Obturator
•Two (2) types •Acquired •Congenital
Groin hernia•Inguinal
•Direct •Indirect
Depending on the site of origin of sac. And per operatively by relation to the deep
epigastric vessels
Layers of anterior abdominal wall
What is an Direct/ Indirect Hernia?
What is an Indirect Hernia?
• Congenital or acquired weaknesses in TF
• Location: lateral to deep epigastric vessels
• Protrude through deep inguinal ring; may descend into the scrotum
• Men
Deep ring
DIRECT INGUINAL HERNIA
• Acquired weaknesses in TF• Location: Hesselbach’s • Emerge between the deep
epig. artery and rectus abd. muscle and protrude into the ingu. canal but not into the SC.
• More difficult to repair?!• Men
HERNIAS…COMPLICATIONS
• Reducible • Irreducible • Obstructed or incarcerated • Strangulated
COMPLICATIONS
Obstruction • Irreducible• abdominal pain, • distension and vomiting may occur • The hernia will be tense tender and irreducible
Strangulation • become red and tender, • Irreducible• No impulse on cough.• If contains bowel signs of obstruction.
INGUINAL HERNIA REPAIR RATIONALE
TENTION FREE REPAIR
MESH REPAIR
HERNIA…PRINCIPLES OF REPAIR
Irrespective of approach used the following will be achieved
• Dissection of the sac • Reduction / inspection of the contents • Ligation of the sac • Approximation of the inguinal and pectineal ligaments