Hernia

Hernia Dr. Rekha Pathak, Senior scientist, IVRI

• Def:• Protrusion of body

cavity contents• Into normal / Abnormal

opening in the wall of that cavity

• To lie beneath the intact skin or to occupy another body cavity

Constituent of herniaRing, Sac and Contents

• H. Ring:• Rupture of abdominal

wall- Ventral hernia• Diaphragm is the

limiting wall: DH• Normal opening/

Passage: Inguinal ring / canal

Sac

• In external hernia-• Skin• M.fibres• Fibrous tissue• Parietal peritoneum

Contents

• Intestine• Omentum• Liver• Spleen• Bladder• uterus

Classification of hernia

• 1. OCCURRENCE • Congenital • Aquired

• 2. LOCATION:External : has ring , sac and contentsEg: ventral, lateral , inguinal (bubonocele), scrotal

umblical(exomphalos, omphalocele) , perineal

Internal: no sacEG. DH, gut- tie (occasional)

Interstitial : between the abdominal muscles

Classification of hernia

• 3. According to contents• Enterocele• Epiplocele• Enteroepiplocele• Gastrocele• Reticulocele• Vesicocele• Hysterocele

Classification of hernia

• 4. Depending on cause:• Traumatic H.• Infectious H.

• 5.Based on functional alteration

• Reducible- contents returned through ring into original position

• Irreducible – adhesions(sac and contents)

• Incarcerated- voluminous contents due to venous congestion

• Strangulated- necrosis and extensive adhesions

Diagnosis

• Symptoms:• 1. Physical :

• Swelling – variable in size

• (abscess, hematoma , cyst, neoplasm )- aseptic exploration

• Palpation of ring• Consistency of sac: enterocele(elastic), epiplocele

(doughy)

Diagnosis

• Functional symptom• Absent in reducible and

non- complicated hernia• Colic in incarcerated

hernia• Severe pain, temp.etc

Radiography

Complications of hernia

• Adhesions• Hydrocele of sac• Incarceration-absorption of water in enterocele-

making reduction difficult• Torsion• Strangulation-called as acute hernia

Umblical hernia

• Common in dogs and bovine calves

• Rare in lambs & kids• No gender

predisposition, among ruminants- common in females

• Congenital/ aquired • Congenial – hypoplastic

rectus muscles and aponeurosis of oblique muscle(wide thin linea alba from xiphoid to pubis )- DH

• Aquired: cord cut close to abdomen

• Bitch chews • Rough handling• Excessive

straining(diarhoea/ constipation)

• Infection of cord• Congenital/ aquired –

primarily hereditary – size- H.ring- recessive genes(2 or more)

Clinical signs

• Swelling • Ring • Contents – omentum / fat/ intestinal loop• More voluminous content/ adhesions- ring not

felt- RG diagnosis

Treatment

• Conservative: belly bandages/ wooden or metal clamps

• Reducible- small content• Dorsal recumbency- reduce manually the

contents- clamp the empty sac- jaw of clamp and tighten the nuts

• Aim : to obliterate hernial sac – stimulate healing of the ring

• Sac – necrosis- sloughs down – 10- 12 days• Skin wound- heals by 2nd intention• Inject irritants – HCL/ H2so4- around ring-

stimulate fibrous tissue formation

Radical surgery

• 12-24 hrs fasting• Local infiltration/GA• Dorsal recumbency

• Midline/ extended past craniocaudal limits on the ring

• In large hernia- elliptical incision – removal of isolated skin

• Open the sac • More

content and small ring- go for kelotomy

• Reducible – invert the contents

• if large and adhesions: remove

1. Bet. Sac(inner wall) and contents

2. Bet. Sac with skin/muscles

Edge of ring – debrided

If sac is big- remove the sac

• Series of simple interrupted / horizontal mattress

• Chromic catgut/ silk / monofilament/ steel/ nylon

• Overlapping mattress- non – absorbable- tighten from centre to periphery

• Wide wall disruption- tension on apposition of edges

• To relieve- external laminae of rectus sheath- incised on each side of incision – relieve tensionand achieve apposition of sutured H. ring

• Alternatively, Hernioplasty

Hernioplasty(Hernial Prosthesis)

• Large h. ring• Weak spot(scar) present• Large loss of tissue on edges

• Allow approximation without tension

• Bridge the gap• Avoid reccurrence of hernia

Living (fresh and preserved)

• Skin- full thickness, autologous whole skin graft (DH)

• Duramatter• Muscle• Fascia lata- lumbar

area- no tissue reaction

Non – living

• Metallic : stainless steel

• Synthetic: Nylon, teflon, Marseline, Marlex, dacron, etc

• Mesh/sheets

• Mesh – prefferred1. More flexibility2. Permits infiltrative fibrosis-

scaffold – ingrowth- fibrous CT3. Minimal tissue reaction and

adequate strength 4. 15x30 cm

Techique • Remove sharp ends and

corner• Close muscle defect• Edge of mesh – sutured-

surrounding fascia with non- absorbable material in a horizontal mattress pattern

• Close the skin