Hernia

The direct inguinal hernia begins just above the pubic crest and protrudes outward and rarely extends into the scrotum. Direct inguinal hernias are relatively uncommon in women.

Groin

The most common of abdominal wall hernias, affecting both, men and women. It begins beneath the surface at what is known as the internal (deep) inguinal ring, a point at which several abdominal muscles overlap.

Groin

The femoral hernia will present just below the groin on the inner thigh. The femoral hernia follows a course parallel to the femoral vein. The hernia occurs when the defect forms adjacent to the femoral vein, allowing preperitoneal fat, greater omentum and sometimes bowel, slip through the defect. The potential for incarceration and strangulation is higher than all other hernias combined. This type of hernia is more common in women.

Groin

The umbilical hernia presents at the belly button and is usually a result of a weakness which has been present from birth. Obesity and liver cirrhosis can be aggravating factors as can pregnancy. These hernias are often seen in infants.

The epigastric hernia is classified as a ventral hernia and is common to both men and women. Epigastric hernias are usually a result of congenital weakness combined with intra-abdominal pressure. The bulge can be quite small and feel fatty to the touch or it can become quite large.

An incisional hernia is an acquired hernia which presents through a weakness created by a previous surgical procedure. It can present wherever the scar is located on the abdomen. The hernia protrudes through a weakened abdominal wall behind the scar and creates a bulge on the surface.

• An imaginary triangle bordered by epigastric(lateral) fold lateral, rectus abdominis muscle medial and iliopubic tract distal. In this area medial inguinal hernias occur.
• -Used in laparoscopic procedures

• The area of groin, imaginary divided into three parts with the internal inguinal ring as the centre of the circle, then in the third lateral of deferent duct and distal of iliopubic tract is the section where most of blood vessels and nerves take course. Thus attention is necessary and it is not necessary to affix clips and stitches at this area because of pain and bleeding as result. The second set of sutures after change of the direction The first set of continuous sutures-distal free margin with backside of aponeurosis.
• -Used in laparoscopic procedures

Location where tissue protrudes through abdominal wall

Tissue of abdominal wall (peritoneum..) that protrudes together with bowel and forms a sac for it

intestine is trapped, the structure(bowel) in hernia sac is strangulated and blood supply interrupted. Immediate surgery is necessary, otherwise necrosis of strangulated structures occurs.

Bassini and Shouldice repair. An incision is made over the site of the hernia, the protruding tissue is returned to the abdominal cavity and the sac that has formed is removed. The surgeon repairs the hole or weakness in the abdominal wall by sewing strong surround muscle over the defect. Because recurrence rate is higher, tension repair methods has been declining in recent years in favour of tension-free prosthetic repairs.

normal open inguinal approach, using a small mesh, which is situated on muscles. A common and successful method, usually done in local anaesthesia.

using a large mesh positioned under muscles preperitoneal

put plugs( wrapped mesh)through internal inguinal ring

• Steps of the procedure normal laparoscopic approach opening of peritoneun over
• the site of the hernia preparation of the inside structures of groin area a mesh patch 10 to 15 cm is positioned on the posterior site of groin, affixed with clips or not closure of peritoneum
• A helpful procedure if the surgeon needs an intra-abdominal overview and if there is a suspicious inguinal hernia on the other side.

• Steps of the procedure approach more in hypogastric region without opening the
• abdominal cavity insufflations of carbon dioxide between abdominal wall and peritoneum(extra-peritoneal) an artificial space is formed (balloon dilatation) over the site of the groin a mesh patch 10 to 15 cm is positioned pre- peritoneal over the site of the hernia,not affixed with clips
• Advantage of this procedure is not to open abdominal cavity. But there is a relatively large wound space in abdominal wall.

Lichtenstein or Shouldice methods, depending on regional preferences. These repairs are performed either in Local-or in Lumbar-anaesthesia .

Laparoscopic hernia repairs- TAPP, TEP. These procedures are performed in general anaesthesia