INGUINAL HERNIA

dr Stefanus Nangoi,
M.Biomed, SpB
 Definition
• “A hernia is an abnormal weakness or hole in an
anatomical structure which allows something inside
to protrude through”.
• It is commonly used to describe a weakness in the
abdominal wall.
• Hernias by themselves usually are harmless, but
nearly all have a potential risk of having their blood
supply cut off (becoming strangulated).
• If the blood supply is cut off at the hernia opening in
the abdominal wall, it becomes a medical and surgical
emergency.
AETIOLOGY
 COMPOSITION OF A HERNIA
• The Sac
– Consisting : mouth, neck, body and fundus
– Diameter of neck  narrow  strangulation
• The covering
– Layer of abdominal wall
• Contents
– Omentum (omentocele / epiplocele)
– Intestine (enterocele)
– Richter’s hernia
– Littre’s hernia
CLASSIFICATION
CLASSIFICATION
ANATOMY OF INGUINAL CANAL
Direct inguinal hernia Indirect inguinal hernia
 COURSE OF INDIRECT INGUINAL HERNIA
Vas deferens, testicular vessels and genital branch of
Loop of bowel entering hernia sac genitofemoral nerve entering spermatic cord

Neck of hernial sac

Inferior epigastric vessels
Origin of infundibuliform (internal
spermatic) fascia
Peritoneum
Extraperitoneal areolar tissue
Transversalis fascia

External spermatic (intercolumnar) fascia

Superficial inguinal ring
Cremasteric fascia
Hernial sac
Infundibuliform (Internal Spermatic) Fascia
Vas deferens and vessels of spermatic cord
 Strangulated inguinal hernia

Inguinal hernia incarcerated

due to old thickened sac and
adhesions

Inflamed appendix in hernial sac

 Clinical Features

• Expansile cough
• Transillumination test
• Finger Test
• Thumb Test
• Ziemen Test (Three
finger Test)
DIFFERNTIAL DIAGNOSIS IN THE MALE

• Encysted hydrocele of the cord

• Femoral hernia
• Incompletely descended testis in the
inguinal canal
• Lipoma of the cord
DIFFERNTIAL DIAGNOSIS IN THE FEMALE

• Hydrocele of the canal of Nuck

• Femoral hernia
 Treatment
• Operation is the treatment of choice
 Surgery
• Herniotomy
• Herniorrhaphy
– Bassini’s Repair
– Shouldice Repair
• Hernioplasty
– Lichtenstein
• Laparoscopic Repair :
– TAPP (Transabdominal
approach)
– TEP (Preperitoneal
approach)
Surgical Technic
BASSINI REPAIR
LICHTENSTEIN TECHNIQUE
(TENSION FREE REPAIR)
The polypropylene
mesh laid down
onto the posterior
wall of the inguinal
canal (the
transversalis
fascia).
Note the end tails
of the mesh patch
embracing the cord