Hernia

A Hernia is the protrusion of an part or whole of the viscus through the abnormal  opening of abdominal wall.

Hernia of Abdominal Wall

According to Anatomical location:

• Inguinal Hernia (Direct and Indirect)
• Femoral
• Midline Hernia
• Umbilical Hernia (Infantile, Adult, Omphalocele)
• Epigastric
• Lumbar

According to etiology:

• Congenital
• Acquired

According to Clinical presentation:

• Complete
• Incomplete
• Reducible
• Non reducible
• Traumatic
• Post Operative
• Complicated (Incarcerated and Strangulated)
• Non complicated

Cause of Hernia

• weakness in Abdominal wall due to physical stress, Aging, injury or surgery
• Increase abdominal pressure due to pregnancy, excessive cough, constipation, overweight, Ascites, tumor etc.
• Congenital defect (failure of abdominal  wall to close properly)

Epigastric Hernias

It is more common in Men than Women. Epigastric Hernias

occurs due to weakness or opening in muscle of upper Abdominal wall (Between Xiphoid process of sternum and umbilicus)

Hiatal Hernia

Hiatal Hernia is result of weakness in the diaphragm. which is dome shaped organ that separate thorax and abdomen. Hiatal Hernia cause reflux of gastric content into esophagus that lead to erosion of esophageal epithelium so that patient ’s complain heart burn and pain.

Umbilical Hernia

Protrusion of abdominal viscera through umbilicus. Which has a Natural weakness from the blood vessel of the Umbilical cord. Umbilical hernia that may be reducible or Non reducible. If Non reducible  hernia, it needs to repair as soon as possible.

Direct Inguinal Hernia

Direct Inguinal Hernia is type of Inguinal Hernia, where protrusion of abdominal viscera medial to the Inferior epigastric vessels (Through Hasselbach's Triangle ). In Direct Inguinal Hernia, Abdominal viscera passes through superficial inguinal Ring.

Indirect Inguinal Hernia

Indirect Inguinal Hernia is type of Inguinal Hernia, where protrusion of abdominal viscera lateral to the Inferior epigastric vessels. In Indirect Inguinal Hernia, Abdominal viscera travel through the Deep inguinal Ring to superficial inguinal Ring.

Hasselbach's Triangle

Inguinal triangle also called Hasselbach's Triangle. which is made up off lateral margin of Rectus abdominis, Inguinal ligament and Inferior Epigastric Vessels(Artery and vein)

Borders of Hasselbach's Triangle

Medial: Lateral margin of Rectus abdominis

Inferolateral: Inguinal ligament

Superolateral: Inferior epigastric vessels

Hasselbach's Triangle

Incarcerated  Hernia

Non reducible( Not able to push abdominal viscera into their natural position) manually, Increase risk of strangulation.

Strangulated Hernia

When vascular supply of viscera is cut off, lead to increase risk of Ischemia.

Femoral Hernia

Protrusion of Abdominal viscera through a weak point or tear   in Upper inner thigh muscle(Through Femoral Triangle)

Femoral triangle

Femoral triangle is Anatomical region of the Upper inner thigh. This area formed superiorly by the inguinal ligament, medially by the adductor longus muscle and laterally by the sartorius muscle

The femoral triangle is bounded by:

• (superiorly) by the inguinal ligament.
• (laterally) by the medial border of the sartorius muscle.
• (medially) by the medial border of the adductor longus muscle.

Floor: Ileopsoas Muscle, Pectinous Muscle and Adductor Longus muscle.

Content of Femoral triangle

Femoral triangle

• Femoral Nerve (Outside femoral sheath)
• Femoral Artery
• Femoral Vein
• Lymph vessels

Symptoms of Hernia

• Pain in affected Area
• swelling
• Feeling of heaviness in abdomen
• Discomfort
• Heartburn and upper abdominal pain in hiatal hernia.

Treatment of Hernia

• Umbilical Hernia may heal themselves with in four years (In babies)
• Other form of Hernia is repaired by Hernia Repair surgery (also called herniorrhaphy or hernioplasty).

Herniorrhaphy (Hernioplasty) is a surgical procedure. Which can be divided in to three technique:

• Open tension repair: Edge of the defect are sewn back together without any Reinforcement or prosthesis.
• Open tension free repair: The placement of synthetic mesh (which are made from polypropylene or polyester) to strengthen the Inguinal region. Nowadays, almost all hernia is repaired by open tension free repair method.
• laparoscopic repair: This method also tension free, although the mesh is placed within the pre peritoneal space behind the defect as opposed to in or over it.

Complications of Hernia

• Irreducibility
• Obstruction
• Strangulation (when blood supply of this area is cutoff due to compression at hernial orifice)