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Indirect Inguinal Hernia

-an

opening or weakness in the muscular structure of the wall of the abdomen. This defect causes a bulging of the abdominal wall. This bulging is usually more noticeable when the abdominal muscles are tightened, thereby increasing the pressure in the abdomen. -A highly common medical problem that may be the result of genetic disposition or of strenous activities such as heavy lifting.

Indirect

Hernia- the result of the failure of embryonic closure of the internal inguinal ring after passage through it of the testicles and the trailing supply of blood vessels and nerves which make up the spermatic cord. Direct Hernia- protrudes through a weakened area in the back of the inguinal canal, entering the inguinal triangle, an area defined by rectus abdominis muscle, the inguinal ligament and the inferior epigastric artery.

Although

abdominal hernias can be present at birth, others develop later in life. Some involve pathways formed during fetal development, existing openings in the abdominal cavity, or areas of abdominal-wall weakness.

Any condition that increases the pressure of the abdominal cavity may contribute to the formation or worsening of a hernia. Examples include > obesity > heavy lifting,

>coughing
> straining during a bowel movement or urination, > chronic lung disease, and > fluid in the abdominal cavity.

A family history of hernias can make you more likely to develop a hernia.

The

signs and symptoms of a hernia can range from noticing a painless lump to the severely painful, tender, swollen protrusion of tissue that you are unable to push back into the abdomen (an incarcerated strangulated hernia).

Reducible

hernia

>>It may appear as a new lump in the groin or other abdominal area. >>It may ache but is not tender when touched. >>Sometimes pain precedes the discovery of the lump. >>The lump increases in size when standing or when abdominal pressure is increased (such as coughing). >>It may be reduced (pushed back into the abdomen) unless very large.

Irreducible

hernia

>>It may be an occasionally painful enlargement of a previously reducible hernia that cannot be returned into the abdominal cavity on its own or when you push it. >>Some may be chronic (occur over a long term) without pain. >>An irreducible hernia is also known as an incarcerated hernia. >>It can lead to strangulation (blood supply being cut off to tissue in the hernia). >>Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting.

Strangulated hernia
>>This is an irreducible hernia in which the entrapped intestine has its blood supply cut off. >>Pain is always present, followed quickly by tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting). >>The affected person may appear ill with or without fever. >>This condition is a surgical emergency.

EXTERNAL MALE GENITALIA Testes -two glandular organs, suspended outside the abdominal cavity in the scrotum -dual functions: >>spermatogenesis >>secretion of testosterone Scrotum - a cutaneous pouch which contains the testes and parts of the spermatic cords

Epididymis

-hoodlike structure lying on the testes and containing winding ducts that lead into the vas deferens Penis -organ for both copulation and urination - consists of the glans penis, the body and the root

INTERNAL MALE GENITALIA Vas deferens - runs upwards from the epididymis through the inguinal canal into the pelvic cavity and arches over the bladder -empties into the ejaculatory duct that carries the sperm through the process to empty into the urethra. Ejaculatory duct - passes through the prostate gland to enter the urethra

Urethra

- tube that carries urine Seminal vesicles - act as reservoir for testicular secretions Accessory Organs >> Prostate gland- surrounds the urethra -produces secretions that are suitable to the needs of the spermatozoa in their passage from the testes >> Cowper glands- below the prostate -empties its secretions into the urethra during ejaculation providing lubrication

All

newly discovered hernias or symptoms that suggest you might have a hernia should prompt a visit to the doctor. Referral to a surgeon should generally be made so that the need for surgery can be established and the procedure can be performed as an elective surgery and avoid the risk of emergency surgery should your hernia become irreducible or strangulated.

If

you find a new, painful, tender, and irreducible lump, it's possible you may have an irreducible hernia, and you should have it checked in an emergency setting. If you already have a hernia and it suddenly becomes painful, tender, and irreducible, you should also go to the emergency department. Strangulation (cut off blood supply) of intestine within the hernia sac can lead to gangrenous (dead) bowel in as little as six hours. Not all irreducible hernias are strangulated, but they need to be evaluated.

INGUINAL HERNIA REPAIR Inguinal hernia repair is surgery to repair a hernia in the abdominal wall of your groin. A hernia is tissue that bulges out of a weak spot in the abdominal wall. Your intestines may bulge out through this weakened area. During hernia repair, this bulging tissue is pushed back in. Your abdominal wall is strengthened and supported with sutures (stitches), and sometimes mesh.

You will probably receive general anesthesia(asleep and pain-free) or spinal anesthesia for this surgery. If your hernia is small, you may receive local anesthesia and medicine to relax you. You will be awake but pain-free. In open surgery, your surgeon will make a cut near your hernia. Your surgeon will find the hernia and separate it from the tissues around it. Then your surgeon will remove the hernia sac or push the intestines back into your abdomen. Your surgeon will close your weakened abdominal muscles with stitches. Often a piece of mesh is also sewn into place to strengthen your abdominal wall. This repairs the weakness in the wall of your abdomen.

Repair of a herniation (protrusion) of the abdominal contents, caused by a musculofascial defect in the abdominal wall or groin area.

Position

Supine, with arms extended on armboards Incision Site Groin area, right or left oblique. Packs/Drapes Laparotomy pack or minor pack Four folded towels Instrumentation Basic tray or minor tray Army navy & Richardson retractors

Supplies/

Equipment

Basin set Suction Needle counter Dissector sponges Sutures Solutions saline, water Synthetic mesh Skin closure strips

Procedure 1.The surgeon begins the procedure by incising the groin. 2.The incision is deepened using the Metzenbaum scissors and cautery is used to control small bleeders. 3.Both blunt and sharp dissections are used to gain access to the hernia. 4.After incising the fascia that lies over the spermatic cord (male), several small hemostats are placed on the edge of the incised fascia. 5.If direct, the surgeon will begin to suture the defect using interrupted suture of varying materials 6.If indirect, the surgeon will dissect the sac away from the cord using Metzenbaum scissors, the sac is opened and the edges grasped with hemostats. 7.The contents of the sac are pushed toward the abdomen and if small, the sac may be lighted in place.

Risks for this surgery are:


Damage

to other blood vessels or

organs Damage to the nerves Damage to the testicles if a blood vessel connected to them is harmed Long-term pain in the cut area Return of the hernia

Hernia Prognosis
Risk

of strangulation: In considering when to have a reducible hernia surgically repaired, it is important to know the risk of strangulation.
The

risk varies with the location and size of the hernia and the length of time it has been present. In general, hernias with large sac contents with a relatively small opening are more likely to become strangulated. Hernias that have been present for many years may become irreducible.