Inguinal Hernia

Inguinal Canal

Boundaries

Inguinal Hernia
Protrusion of abdominal contents through
weakness or defect in abdominal wall at the exit
point, superficial inguinal ring.
Accounts for 75% of all abdominal wall hernias
9:1 male predominance
Higher incidence among men 40 to 59 years of
age.
Mainly two types:

Criteria

Direct Inguinal Hernia

Indirect Inguinal Hernia

Course

Via transversalis fascia

(Hesselbachs triangle)

Via deep inguinal ring

Relation

Medial to IEV

Lateral to IEV

Broad

Narrow

Weakness in abdominal
wall

Patent processus vaginalis

Elderly

Young

Deep Ring
occlusion
test

Bulge out

Does not bulge out

Reduction

Spontaneously

Manually

Neck
Etiology
Age

Case
51 year old, Malay male
Presented with swelling on the right inguinal area
for the past 1 year.

History Taking
1. Prior episode
2. Onset, Progress
3. Swelling size, pain or signs of inflammation,
discharge,
reducibility, other sites
4. Aggravating or Relieving factors
5. Predisposing factors
6. Systemic symptoms IO symptoms, fever, LOA,
LOW, trauma,
LUT symptoms
7. Past Medical, Past Surgical, Family,
Medication/Allergy, Social history

Physical Examination
1. Swelling
. Position, Single or bilateral, Size, Shape, Surface,
Consistency, Tenderness, Warmth, Skin changes,
Transillumination, Pulsations
. Cough impulse
. Deep ring occlusion test

Clinical Features
1. Groin pain, heavy or dragging sensation while
doing work/exercise
2. Signs and symptoms of IO
3. Scrotal swelling
4. Predisposing factors chronic cough, strain
during micturition, constipation or previous
abdominal surgery

Complications

Management
Surgical:
Conventional open hernia repair
Laparoscopic hernia repair
Repair Procedures:
Herniotomy
Herniorrhaphy
Hernioplasty

Strangulated vs Reducible
Hernia
Criterion

Strangulated hernia

Reducible Hernia

Preoperative Management
Status

Emergency

Elective

IV fluids

Resuscitate

Not needed

Antibiotics

Therapeutic

Prophylactic

X-match blood

Essential

Not needed

Nasogastric
suction

Essential

Not needed

Needed

Not needed

Bladder
catheter

Criterion

Strangulated Hernia

Reducible Hernia

Peroperative Management
Over most prominent
part of sac

Groin

Top priority

Not needed

Viability of bowel

Check +/- resect

Not needed

Division of
constricting ring

Essential

Not needed

Only done if condition

permits

Always done

Site of incision
Draining sac

Repair of hernia

Criterion

Strangulated Hernia

Reducible Hernia

Post-operative Management
Blood transfusion

May be needed

Not needed

Antibiotics

Continue

Stop

Feeding

Delayed

A.s.a.p

IV fluids

Continue till patient eat

normally

Discontinue

> 2%

< 2%

Chance of
wound infection