Herniae Flashcards
Df of hernia of the anterior abdominal wall
Its the exit of the inside from the abdominal cavity together with the parietal leaf of the peritoneum through the natural or acquired holes in the muscular-aponeurotic layer
Component of external abdominal hernia
1- hernial gates
2- hernial contents
3-hernial sac
Classification of hernia
—we have multiple classifications:
1-internal : such as
1.1 hernia of the duodnal-jeuojenal pocket
1.2 Retrocecal hernia
1.3 hernia of omental sac
1.4 Diaphragmatic hernia
2-external : such as
2.1 inguinal hernia ( male often )
2.2 femoral hernia. ( female often)
—classification by etiological bases :
1. Congenital
2. Acquired
—classification by clinical features:
1.Reductive
2.irreducible
3.usual
4.restrained
5-Moving
Explain types of inguinal hernia and the difference
— we have two types
1-direct ; the herniated organs passes through the medial inguinal fossa and never enters the scrotum , and its located separately from the spermatic cord
2-Oblique: the herniated organs passes through the lateral inguinal fossa and inguinal canal and enters the scrotum and its located with spermatic cord
What is the stages of inguinal hernia repair
1-pain relief
2-access
3-isolation if hernial sac
4-opening the bag and revision of its contents
5-high ligation of the hernial sac
6-cutting off the bag at the nick level
7-plastic hernia gate
Explain the procedure of hernia dissection
1- layer by layers tissue dissection : its carried out in parallel and 2 cm above the inguinal ligament
2-dissection of hernial gates : a dissection of the superficial inguinal ting and aponeurosis of the external oblique abdominal muscle is carried out along the grooved probe
3-allocation of the hernial sac : isolation of the hernial sac from the elements of the spermatic cord is carried out by dissecting the common vaginal membrane of spermatic cord and testicle
4-opening of the hernial sac : the hernial sac is opened in the area of the bottom and its contents are set in the abdominal cavity
5-ligation and clipping of the hernial sac : an elongated neck of the sac as possible should be stitched with catgut , and the peripheral portion of the sac distal to ligature is cut away
Methods of plasty of the inguinal canal
— for each type of inguinal hernia we have a certain types of methods
1-direct hernia: strengthening the post wall of the inguinal canal with movement of the spermatic cord and its carried away by these methods :
1. Methods of bassini
2.method of kukudazhanov
—-
2-oblique hernia: strengthening the Ant wall of the inguinal canal without movement of spermatic cord and its run by these methods :
1.spasokukotosky method
2.kimbarovsky method
Explain the inguinal triangle (borders ) and explain the inguinal canal ( walls )
—inguinal triangle borders :
-superior : horizontal line drawn between lateral and middle 1/3 of the inguinal ligament
-medial : lateral margin of the rectus abdominis muscle
—
-inguinal canal walls :
1-anterior : Aponeurosis of the external oblique muscle
2-Posterior: transvalis facia
3-superior/roof : inf border of the internal oblique and transversus abdominis ms
4- inferior/floor : inguinal ligament
—and its contents :
1. In male : spermatic cord and ilioinguinal nerve
2. In female: round ligament of the uterus , ilioinguinal nerve and genital branch of the genitofemoral nerve
Explain the Strangulated hernia Df,types
-Df : its hernia which the hernial sac is compression of the fallen organs , followed by violation of the function, blood supply and innervation of these organs
-types :
1-Parietal ( rechter lettier ) : hernia which a portion of the bowel is strangulated
2-Retrograde . Hernia in which sole loops of the bowel are strangulated ( W-Shaped hernia )
3-Elastic strangulation: hernia which occurs duo to external pressure of vessels
4-Facal strangulation: hernia which occurs duo to internal pressure exerted by fecal mass
5-Sliding hernia : the hernial sac is represented partially by the wall of the hollow organ , not covered by the peritoneum
Explain herniatomy with a strangulated oblique inguinal hernia
1-layer by layer : dissection of soft tissue to aponeurosis of the external oblique abdominal muscle
2-isolation of the hernial sac and open it
3-an audit of the hernial content
4-Dissection of the restraining ring outward and upward
5-Extraction of the infringed organ from the abdominal cavity
6-if necessary the issue of resection of the body
7-ligation and excision of hernial sac
8-plastic hernial gates
Explain hernitomy by Lichtenstein
-its method of non-tension hernioplasty , which allows to perform surgery for large defects of the anterior abdominal wall , including recurrent hernias , to replace the defect of anterior abdominal wall , A mesh is used
Explain the methods of surgical treatments of femoral hernias
—we have two types :
1-typical : which is from the femoral canal side :Ex Lockwood-bassini method
2-Atypical : which is from the side of inguinal canal : Ex , Ruiji method , reich method , Parlavichioo method
Explain the approaches for surgery of femoral hernias
1-an oblique incision above the inguinal ligament
2– T shaped incision
3- angled incision
4-vertical section
5- an oblique incision below the inguinal ligament
Classification of umbilical hernias
1-Embryonic
2-hernia of umbilical cord
3-New born hernias
4-hernias of childhood
5-adult hernias
Explain method for treatments of umbilical hernias
—we have two types :
1-Extraperitonal method : adhesive plaster method
2-interaperitonal method : lexer method ,mayo method
Explain skin incision during umbilical hernia surgry
-they are 3
1 - the midline incision of the abdomen to the navel;
2 - semilunar incision surrounding the belly button bottom,
3 - edging cut.
Explain the procedure of sliding hernia
-With sliding hernias, one of the walls of the hernial sac is the organ not partially covered by the peritoneum (cecum, bladder).
After opening the hernial sac, the stitched ligature is applied distal to the organ that is its wall. Ex Savario method
Explain methods of surgical treatment of inguinal hernia in children
—there is two ways :
1-Without opening of inguinal canal : ex Ru krasnobaev , Ru oppel methods
2-with opening of the inguinal canal : martynov method
Explain the difference between congenital and acquired hernia
1-In congenital inguinal hernias, the hernial sac is built by the vaginal process peritoneum, which also participates in the serous coating of the testicle.
2-With acquired inguinal hernias, the hernial sac together with the hernial contents are located separately from the testicle.
