2018 HMO Teaching By Dr Pith Soh Beh Definition Relevant anatomical terms Hernia Types of Hernia Definition Relevant anatomical terms Hernia Protrusion through an opening Last Anatomy ID: 927511
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Slide1
Management of Inguinal Hernia
2018 HMO TeachingBy Dr Pith Soh Beh
Slide2Slide3Definition
Relevant anatomical terms:Hernia
Types of Hernia
Slide4Definition
Relevant anatomical terms:Hernia
Protrusion through an opening (Last Anatomy)
Protrusion of viscera through anatomical boundaries (Washington Handbook of Surgery)
Types of Hernia
Inguinal
umbilical
Femoral
Hiatus
Obturator
Lumbar
Spigelianincisional
Slide5Slide6Inguinal Hernia
Types of Inguinal Hernia:
Slide7Inguinal Hernia
Types of Inguinal Hernia:Direct
Indirect
Richter’s
Pantaloon
Slide8Inguinal Hernia
Slide9Inguinal Hernia
Slide10Relevant Anatomy
Inguinal canalBoundaries:
Superior:
Inferior:
Posterior:
Anterior:
Contents
Spermatic cord
3
3
3 +1
3 Female?
Slide11Relevant Anatomy
Inguinal canal
Boundaries:
Superior: transversalis, transversus abdominis/internal oblique
Inferior: rolled edge of inguinal ligament
Posterior: transversalis, transversus abdominis/internal oblique
Anterior: transversus abdominis/internal oblique, external oblique
Contents
Spermatic cord
3 arteries (testicular artery, artery to the vas, cremasteric artery)
3 nerves (
genitalfemoral
,
sympathetics
, ilioinguinal*)
3 stuffs (vas, pampiniform plexus,
processus
vaginalis) + lymphatics
3 layers (external spermatic fascia, cremasteric fascia, internal spermatic fascia)
Female?
round ligament, ilioinguinal nerve
Slide12History and Clinical Exam (1)
History:
Past
Hx
/ Risk Factors
Exam:
Slide13History and Clinical Exam (1)
History: Lump, pain, vomiting/nausea
Past
Hx
/ Risk Factors
Previous hernia
Heavy lifting
Smoker / chronic cough
Connective tissue disease, steroid use, Exam:
Palpate over suspected hernia site
Elicit cough impulse
Augment by getting patient to stand up
Slide14History and Clinical Exam (2)
Relevant anatomical landmarks for inguinal hernia
Slide15History and Clinical Exam (2)
Relevant anatomical landmarks for inguinal hernia
Public tubercle, symphysis
Mid-inguinal point, mid point of inguinal ligament
Slide16History and Clinical Exam (2)
Relevant anatomical landmarks for inguinal hernia
Public tubercle, symphysis
Mid-inguinal point, mid point of inguinal ligament
Slide17Investigations
Adjuncts? ECG
Urine dipstick
Pathology
FBE
UEC
VBG
Imaging
XRay
Ultrasound
CT
Slide18Management
DRABCSymptomatic relieve (pain, nausea)
Non-operative
Reassurance
Avoid trigger (tight undies, completing online manual handling protocol & adhering to it, quit smoking)
Surgical management
*Should I push it in?*
🤔
Slide19Manual Reduction
ReducibleIrreducible / Incarcerated
Obstructed
Strangulated
Slide20Manual Reduction
Reducible 💯
Irreducible / Incarcerated
Obstructed
Strangulated
🙅
Slide21Surgical Management
(Hernioplasty)Open Surgery
Laparoscopic surgery
Principles of surgery
Tension repair
Tension-free repair
Slide22History of Hernia Surgery (open)
“Those who fail to learn from history are doomed to repeat it”George Santayana
Slide23History of Hernia Surgery (open)
Primary Closure repairBassini
McVay
Shouldice
Tension-free Mesh repair
Lichtenstein
?
Darnings
technique
Slide24History of Hernia Surgery (open)
Bassini
McVay
Slide25History of Hernia Surgery (open)
Shouldice Darning
Slide26Modern Hernia Surgery
Open
Lichtenstein Repair
Slide27Modern Hernia Surgery
LaparoscopicTrans Abdominal Pre-Peritoneal (TAPP)
Totally Extra-Peritoneal (TEP)
Slide28Modern Hernia Surgery - TEP
Slide29Modern Hernia Surgery - TEP
Slide30Modern Hernia Surgery - TAPP
Slide31Modern Hernia Surgery - TAPP
Slide32References
Lasts AnatomyWashington Handbook of Surgery