Hernias

Abdominal Hernias
A protrusion of viscera through an opening in the wall of the abdominal cavity
Hernia Types
Reducible
Incarcerated
Strangulated
Richter’s
Sliding

Hernias
by Anatomical Location
Groin
Inguinal
Femoral
Ventral
Incisional
Diaphragmatic
Ventral Hernias
Anterior abdominal wall
Linea alba
Epigastric (1)
Hypogastric (2)
Umbilical (3)
Semilunar lines
Spigalian (4)
Incarcerated Umbilical Hernia
Direct Inguinal Hernia
Acquired
Indirect Inguinal Hernias
Congenital
Present through the inguinal ring
The sac is confined to the spermatic cord
Inguinal Hernias
Femoral Hernias
Acquired

Femoral Hernias
Instrumentation – Minor set

Instrument Counts
Some facilities require an instrument count on this case because there is a remote chance that the abdomen has to be opened to remove dead bowel

Inguinal Hernia Repair Procedure
Position – supine
Anesthetic – general, MAC, or local
Prep
Drape

Inguinal Hernia Repair Procedure
The skin incision is made and the subcutaneous tissue is dissected, with the bovie, down to the fascia.
The fascia is opened with metzenbaum scissors and forceps with teeth.
Care is taken not to cut the ilioinguinal nerve that lies beneath the fascia
Hemostats are placed on each edge of the fascia for retraction. The hernia sac is disected and a the implant is sewn into place.

The fascia is closed, the adipose, and the skin.

Inguinal Hernia
The Movie
Mesh Plug and Patch Repair
Hernia Repair Procedures
Disc 2
Laparoscopic Nissen Fundoplication
Indications

Lap Nissen
The Movie

Laparoscopic Nissen Antireflux Procedure
Gastroesophageal Surgical Procedures
Disc 4
Reading Assignment for next Class
ST for the ST
318-333
Alexanders
Surgery of the Stomach, Small bowel, Colon, Rectum
Pages 363-393