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Inguinal Hernia

Medecine
by

amela hasa

on 23 July 2014

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Transcript of Inguinal Hernia

IH is a protrusion of abdominal-cavity contents through a weak area in the lower abdominal muscles, in the groin, without disturbing the integrity of the skin.
Surgical Treatment
of Inguinal Hernia
Epidemiology
Although the incidence and prevalence worldwide is unknown, it is estimated that over 20 million surgical procedures for inguinal hernia are performed each year.
The specific operation rates vary between countries, but range from 100 to 300 procedures per 100,000 people per year.
Although inguinal hernia can occur in both sexes, the disorder predominantly affects men (male:female ratio is 7-9:1)
Historical evolution of inguinal hernia repair
Descriptions of hernia reduction date back to Hammurabi of Babylon and Egyptian papyrus
There were used various slings& trusses,warm herbal baths,moist bandages
The first description of the transabdominal approach for hernia repair was written by Demetrius Cantemir(prince of Moldavia) in his 1716 latin manuscript "The history of the growth and decay of the Ottoman Empire".The surgical procedure was performed by Albanian Physicians(from Vlora) in the Prince's palace in Costantinopol.The patient was the Prince's secretary.
The most important repair mechanisms in the surgery of inguinal hernias
Reinforcing the anterior wall of the inguinal canal and narrowing the external inguinal ring (Stromayr, Purmann)
Reinforcing the posterior wall of the inguinal canal and narrowing the internal inguinal ring (Brenner,Bassini,Shaouldice)
-Applying alloplatsic material (Lichtenstein,Stoppa)
Reinforcing the posterior wall of the inguinal canal and narrowing the internal inguinal ring from intraabdominally

-Providing on occasion of laparotomies with different indication( Tait )

-Implanting alloplastic material as vicryl net or Marlex mesh to close hernial opening via laparoscopy
Physiopathology
Imbalance for a long time between internal abdominal blow and mechanical resistance of the posterior wall of the inguinal canal leads to hernia formation
Protective mechanisms
1 . Strong and physiologically dynamic posterior inguinal wall
The posterior inguinal wall is composed of condensed transversalis fascia along with the aponeurotic extensions from the transversus abdominis aponeurotic arch.
The strength of the posterior inguinal wall is directly related to the number of aponeurotic fibers it contains and there is great variation in normal anatomy.
If aponeurotic extensions are absent, then the transversalis fascia alone cannot resist the internal blows for a long period and herniation occurs.
2.Action of musculo-aponeurotic structures around the inguinal canal
This plays an equally important role in preventing the hernia formation.
Various combinations come in to play whenever there is an internal abdominal 'blow' : shielding action + compression action + squeezing action of muscules
+ strength of the interparietal connective tissue
The strong cremasteric fascia(interparietal fibrocollagenous tissue) between the muscle arch and the incurved part of the inguinal ligament keeps muscles dynamic by giving anchorage.
Internal abdominal blow is raised by:
-Excess weight
-Straining during bowel movements or urination
-Heavy lifting
-Fluid in the abdomen (ascites)
-Pregnancy
-Chronic coughing or sneezing
NEW CONCEPTS THAT PREVENT GROIN HERNIA FORMATION
The real factor that prevents hernia formation in the normal individual is presence of aponeurotic extensions from the transversus abdominis aponeurotic arch in first place and strong musculo-aponeurotic structures around the inguinal canal in the second place.
REF: Desarda MP. Surgical physiology of inguinal hernia repair. BMC Surgery 2003
Complications:Irreducibility,incarceration,strangulation,inflammation

During this period, there were treated 64 patients with Inguinal Hernia .The patients were submitted to a questionnaire before the surgery, which was completed with the rest of the details on the first post operatory day.
41% of the patients, related the hernia with heavy weight lifting, 15.4% with cronical coughing, 5.2% with trauma, 2.6% with pregnancy, 25.6% shows familiar history of the disease, and a smaller percentages related it with constipation and disuric problems.
All the patients were treated with open surgical hernia repair. In 87.5% of the patients was applied the synthetic prolen mesh according to the Lichtenstein technique, and in 12.5% of the cases was used the Bassini technique, mainly because of the lack of mesh in emergency.
After surgery, 90.2% of the patients were treated with anticoagulants, 100% with antibiotics, and approximately 2.4 lt perfusions each patient. The pain was treated as follows: 8% of the patients had only NSAIDs, 42 % only opiats and 50% a combined therapy of them.
The average time after surgery needed from the patients to mobilize was 11 hours.
The average hospital stays in unilateral inguinal hernia, was 2 days.
Amela Hasa ,Bora Muhametaj,Erilda Zyka
in collaboration with Prof.Asc.Arvin Dibra

Special thanx to Ergela Hasa :)
The study duration was 15 December 2012 to 15 March 2013, in the First Clinic of General Surgery in University Hospital Center Mother Teresa )
We present a prospective randomized study whose aim is to determine the current treatment for Inguinal Hernia in our Hospitals
RESULTS
The age range was from 25 years to 84,with an average of 58 years.

Mode: 47 Median:58
86% of patients were males and 14% were females
In 15.6% of the cases the hernia was incarcerated and was treated in emergency and 29.7% of the cases the hernia was diagnosed as irreducible
60.9% of the patients presented a right inguinal hernia, 32.8% on the left and in 6.3% the disease was presented as bilateral.
74.5% of patients were hospitalized for the first time for this pathology and 6.4% of them had recidivism
Looking to the disease history, the 84.6% of the patients presented pain and prominent buldge as first symptom, and in 14.5% of them ,vomiting.
Time when the first symptoms occurred goes medially from 1month to 20 years.
By :
First Clinic of General Surgery in University Hospital Center Mother Teresa (QSUT),Tirana,Albania
Inguinal Hernia is a frequent pathology in our wards/hospitals, with a significant impact, both on morbidity and limitation of working capacity.
CONCLUSION
The elected therapy is focused on surgery, if possible, using synthetic protesis according to the Lichtenstein technique.
1680s, from Latin , inguen,"groin"
late 14c., hirnia, from Latin "a rupture,"
related to hira "intestine"
In general, inguinal hernia affects all ages, but the incidence increases with age
A.E.Nicolau Clinic of surgery Emergency Hospital, Bucarest,Romania
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