Hernia PPT.ppt

hernias,zhaoxingeneralsurgerydepartmentthe1staffiliatedhospitalofsoochowuniversity,historicalhernias,herniashavebeendocumentedthroughouthistorywithvaryingsuccessateitherreductionorrepair.,trussesvalsalvamaneuverisrepeateddifferentiationbetweenindirectanddirectherniasatthetimeofexaminationisnotessential,examination,alsoassesthefollowing:positiontemperaturetendernessshapesizetensioncompositionexpansilecoughimpulsereducible.percussionandauscultation:bowelsound.,herniaexam,diagnosis,physicalexamincarceratedherniassometimescanbereducedmanuallygentlecontinuouspressureonthehernialmasstowardstheinguinalringisgenerallyeffectiveinstandingposition+/-valsalvasmaneuverorcoughingreducible(irreducible)massusct,inguinalhernia,maleinguinalhernia,femaleinguinalhernia,inguinalhernia,indirectinguinalherniaisacongenitallesionoccurswhenbowel,omentumorotherabdominalorgansprotrudesthroughtheabdominalringwithinapatentprocessusvaginalisiftheprocessusvaginalisdoesnotremainpatentanindirectherniacannotdevelopmostcommontypeofhernia,indirectherniaroute,note:theherniasacpassesoutsidetheboundariesofhesselbachstriangleandfollowsthecourseofthespermaticcord.,hernia,inguinalherniaindirect,inguinalhernia,directinguinalherniaproceedsdirectlythroughtheposterioringuinalwalldirectherniasprotrudemedialtotheinferiorepigastricvesselsandarenotassociatedwiththeprocessusvaginalistheyaregenerallybelievedtobeacquiredlesionsusuallyoccurinoldermalesasaresultofpressureandtensiononthemusclesandfascia,directherniaroute,note:theherniasacpassesdirectlythroughhesselbachstriangleandmaydisrupttheflooroftheinguinalcanal.,inguinaltriangle(hesselbachstriangle),directhernia,boundedbytheinguinalligament,theinferiorepigastricvessels,andthelateraledgeofrectusmuscle.,differencesbetweenindirectanddirecthernia,incidence,approximately75%ofallherniasoccurintheinguinalregionapproximately50%ofherniasareindirectinguinalherniasavastmajorityoccurinmalesherniasmorecommonlyoccurontherightside,d/dofgroinmasses1)hernia(inguinal,femoral)2)lymphadenitis(lymphoma,tuberculosis,metastaticneoplasm)3)ectopictestes4)lipoma5)varicocele6)hematoma7)psoasabscess8)hydrocele,9)epididymitis10)testiculartorsion11)sebaceouscyst12)femoralaneurysmorpseudoaneurysm,13)hidradenitisofinguinalapocrineglands,treatmentnonoperativetherapyindications:40yearscauses:laxityofgrointissueelevatedintra-abdominalcanalanatomyoffemoralcanalfemoralringfossaovalisanterior:inguinalligamentposterior:pectinealligamentmedial:lacunarligamentlateral:femoralvein,femoralherniaroute,note:theherniasacfollowsthepotentialspacealongthefemoralvessels.itmaybepalpablenearthefemoralringorinthemedialthigh.,femoralhernia,symptoms:femoralherniasaremorecommoninwomen,theytypicallypresentasagroinlump.theymayormaynotbeassociatedwithpain,afemoralherniahasoftenbeenfoundtobethecauseofunexplainedsmallbowelobstruction.signs:anabsentcoughimpulse,withamoreglobularlumpthanthepearshapedlumpoftheinguinalhernia.differentialdiagnoses:inguinalhernia.femoralarteryaneurism.femorallymphadenopathy.psoasabscess.,treatmentnotbetreatedconservativelyruleoperation:excisionorreductionofthehernialsac,andnarrowingofthestretchedfemoralopeningmethods:mcvayrepairtension-freehernioplastylaparoscopicrepairofinguinalhernia,typesofventralhernias,1.umbilicalhernia2.incisionalhernia,incisionalhernia,usuallyoccurasaresultofinadequatehealingfromapreviousincisionorexcessivestrainatthesiteofanabdominalwallscarpostoperativewoundinfectionsarethemostcommoncausativefactorobesityisoneoftheleadingcausesaswellweightreductiontherapyisrecommendedpriortotherepairofanincisionalherniaotherriskfactorsinclude:advancedage,malnutrition,ascites,postoperativehematoma,pregnancyandmanyothers,incisionalherniacauses-inadequatehealingofapreviousincisionorexcessivestrain1)obesity2)infection3)medications:steroidsadvancedagemalnutritionascitespostoperativehematomaperitonealdialysispregnancypostoperativepulmonarycomplication,incisionalherniaoperation1)preventionofrecurrencea.stabilizationofunderlyingmedicalconditioncongenital,2yearslater2.tx1)mayohernioplasty;vestofpentsimbricationofthesuperiorandinferioraponeuroticsegments2)to-and-fro,looselyplacedpolypropylenesuture,3)prosthesisrepair,lumbarhernia1.classification/etiologycongenitalspontaneoustraumatic(nephrectomy)herniation2.petitsinferiorlumbartrianglelatissimusdorsieoamiliaccrestsuperficialfascia3.grynfelttssuperiorlumbartriangle12thribioamusclesacrospinalmusclelatissimusdorsi,rarehernias,richtershernia:noncircumferentialincarcerationofthenonmesentericbowelwalllittreshernia:incarceratedmeckels,rarehernias,sciatichernia:(post.pelvis)herniationthroughthegre