Académique Documents
Professionnel Documents
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Paulus Aegina
Maupassius (1559)
Littre
DeGarengeot
Heister
Pott (England)
Camper (Holland)
Scarpa (Italy)
Hunter
Morton
Cloquet
Hesselbach (Germany)
"corona mortis" (arterial circle formed by the deep epigastric and obturator arteries).
De Gimbernat
Richter (Germany)
Remember anatomic
fascia transversalis
vase cremasterice
m. transvers abdominal
m. oblic intern
m. oblic extern
peritoneu
N. ilioinghinal
funicul spermatic
vase femurale
m. cremaster i fascia
cremaste-ric nvelind
funiculul spermatic
tubercul pubic
fascia spermatic extern
nvelind funiculul spermatic
falx inguinalis (tendonul conjunct)
fibre intercrurale
lig. inghinal (Poupart)
linia alb
m. oblic extern
teaca dreptului abdomi-nal
(foia anterioar)
m. transvers abdominal
tendon conjunct
(falx inguinalis)
fibre intercrurale
lig. inghinal (Poupart)
fascia spermatic extern pe ieirea
funiculului spermatic
creast pubian
linia alb
tract iliopubian
vase epigastrice inferioare
trigon inghinal (Hesselbach)
inel inghinal profund
vase testiculare i ram genital al N. genitofemural
fascia iliopsoasului (acoperind N. femural)
m. iliopsoas
vase iliace externe
tendon conjunct (falx inguinalis)
inel femural (dilatat)
lig. lacunar (Gimbernat)
anastomoz arterial pubo-obturatorie (corona mortis)
canal deferent
lig. pectineal (Cooper)
ram pubic superior
a. obturatorie
simfiz pubian
1.
2.
3.
4.
5.
Punct herniar
h. Interstitiala
H. Inghinopubiana = pubonocel
H inghino-funiculara
H. inghino-scrotala
H inghino-pubiana
H inghino-pubiana
H inghino-scrotala
tract iliopubian
vase epigastrice inferioare
trigon inghinal (Hesselbach)
inel inghinal profund
vase testiculare i ram genital al N. genitofemural
fascia iliopsoasului (acoperind N. femural)
m. iliopsoas
vase iliace externe
tendon conjunct (falx inguinalis)
inel femural (dilatat)
diafragm
fascia diafragmatic
lig. falciform
peritoneu (margini
secionate)
ombilic
peritoneu
fascia transversalis
linia arcuat
(arcada Douglas)
fascia transversalis
m. oblic extern
m. oblic intern
m. drept abdominal
m. transvers abdominal
vase epigastrice
inferioare
trigon inghinal
Hesselbach
fascia transversalis
lig. interfoveolar
Hesselbach
vase circumflexe
iliace profunde
inel inghinal profund
ram cremasteric i
ram pubic ale
a. epigastrice inferioare
N. femural
fascia iliopsoas
m. iliopsoas
inelul femural
teaca femural
lig. lacunar (Gimbernat)
lig. pectineal (Cooper)
tendon conjunct (falx inguinalis)
a. ombilical (parte distal obliterat)
nerv i vase obturatorii
canal obturator
ureter (secionat)
reces anterior al fosei ischioanale
a. vezical superioar
canal deferent
vezicul
seminal
prostat i m. sfincter al uretrei
1.
2.
3.
Hernie inghinala
Oblica-externa
Directa
Oblica interna
Caracteristici
Hernia oblica-externa
Hernia directa
Hernia oblica-interna
Rara
De slabiciune
Sacul contine adesea vezica uriunara
1.
2.
Hernia congenitala
Hernie inghinala
congenitala
1. INGHINOTESTICULARA
2.
HERNIE
CONGENITALA
FUNICULARA
Hernie inghinala
congenitala
3. FUNICULARA CU
CHIST DE
CORDON
SPERMATIC
4.
HERNIE
INGHINALA
CONGENITALA
ASOCIATA CU
HIDROCEL
2.
3.
Inghino-properitoneala
Inghino-interstitiala
Inghino-superficiala
hernie
ALTE CLASIFICARI
Type 1 hernias have a peritoneal sac passing through an intact internal ring that will not
admit 1 fingerbreadth (ie,<1 cm.); the posterior wall is intact.
Type 2 hernias (the most common indirect hernia) have a peritoneal sac coming
through a 1-fingerbreadth internal ring (ie, </=2 cm.); the posterior wall is intact.
Type 3 hernias frequently are complete and often have a sliding component. They
begin to break down a portion of the posterior wall just medial to the internal ring.
Type 4 hernias have a full floor posterior wall breakdown or multiple defects in the
posterior wall. The internal ring is intact, and there is no peritoneal sac.
Type 5 hernias are pubic tubercle recurrence or primary diverticular hernias. There is
no peritoneal sac and the internal ring remains intact. In cases where double hernias
exist, both types are designated (eg, Types 2/4). Descriptors such as L, Sld., Inc., Strang.
Fem. are used to designate lipoma, sliding component, incarceration, strangulation and
femoral components.
Diagnostic diferential
Hernia femurala
Intre tipurile de hernii inghinale OE si D
Hidrocel
Chisturi de cordon
Diagnosticul definitiv
Varicocel
complet de hernie trebuie s
Lipoame
cuprind urmtoarele: tipul
anatomo-clinic, varietatea
Tu testiculare
(direct, indirect), eventualul
Adenopatii
stadiu complicat.
Tratament
Tratament chirurgical
1.
Procedee anatomice
2.
Procedee neanatomice
Retrofuniculare
Prefuniculare
3.
4.
Procedee plastice
5.
Procedee laparoscopice
Anestezie - orice
Cai de abord
Annandale Lawson Tait
Bassini
Babcok-Meingot
Lavarde
Procedeele anatomice
Incizie LaRoque
Manevra
Reymond de
depistare a sacului
Proc Bassini
McVay - Hashimotto
Proc Souldice
Marcy (1871)
Czerny (1876)
Kocher
MacEwen
(1886)
Procedee neanatomice cu
desfiintarea canalului inghinal
Procedee retrofuniculare
POSTEMPSKI
WISSE
Procedee prefuniculare
FORGUE
GIRARD
FERRARIS
PASOKUKOTHI
VILANDRE
TH. IONESCU
BINET
WOFLER
MUGNAI
HALSTEDT
MARTINOV
KIMBAROVSKI
Principiul Martinov
ALB la ALB
ROSU la ROSU
retrofunoicular
prefunicular
Procedee plastice
Cu material autolog
Cu material homolog
Cu material heterolog
Natural
Nylon (1944)
Polyethylene mesh
(1958)
Polypropylene mesh
(1962)
Polyester mesh
(MERSILENE) (1984)
Expanded
polytetrafluoroethylene
STOPPA
WANTZ
Tension free
USHER
PROCEDEE
ENDOSCOPICE
PROPERITONEALE
- 1991 -
PROCEDEE LAPAROSPOPICE
TRANPERITONEALE
GILBERT - 1985
COMPLICATII POSTOPERATORI
Hematoame.
Seroame
Hemoragii din plaga
Supuratii de plaga
Edem scrotal
Necroza testiculara
Recidiva herniara
Nevralgia inghinala
hernie palpabil
unilateral
ncarcerat
reparare laparoscopic
EXAMEN FIZIC
tehnic alloplastic
deschis bilateral
hernie palpabil
bilateral
tehnic alloplastic
deschis n etape
aplicare laparoscopic de plas
blocad a nervului
reexaminare la 1-3 luni
durere persistent n
absena detectrii
vreunei hernii
iritaie nervoas
ntindere muscular