A hernia (or “rupture”) is a weakness or defect in the wall of the abdomen. This weakness be present at birth. Or, it can be caused by the wear and. PDF | Inguinal hernia repair is performed in more than cases every year in the United States. However, the true prevalence be. Background: Inguinal hernia is a common surgical problem, but it can present a surgical dilemma for the skilled surgeon when it exhibits.
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Inguinal hernias are one of the most common reasons a primary care patient need referral for surgical intervention. PDF; Print page. This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the. Beneficios–La única forma de reparar una hernia es una operación. Usted puede regresar a sus actividades normales y, en la oría de los casos.
Inguinal hernias can be subdivided into lateral and medial hernias.
Inguinal hernias are almost exclusively lateral in children 2 , whereas women and men have both subtypes 3. Lateral hernias are more frequent, but medial hernias have a higher risk to recur after repair 4 , 5. Lateral and medial hernias are often treated similarly, even though the described differences in age, sex, and recurrence rates imply different etiologies.
Anatomy and Herniation The inguinal canal starts at the internal inguinal ring and ends at the superficial ring, containing the spermatic cord in men and the round ligament in women. The integrity of the abdominal wall depends on the orientation of the inguinal canal, the transversalis fascia, and the sphincter-like function of the internal ring 6.
A hypothesis to the high incidence of inguinal hernias in humans is that the abdominal wall was well constructed when we walked on four extremities, but that the groin area did not have enough time to adopt when we rose to standing on two legs.
Lateral hernias arise from the internal inguinal ring, presumably through a patent processus vaginalis 7 , and runs in the inguinal canal with or without exit through the superficial ring 8.
Risk Factors for Developing a Primary Inguinal Hernia The risk factors for developing an inguinal hernia can be divided into patient risk factors such as age and sex 9 , 10 , and external risk factors such as physically demanding work 11 , Patient Risk Factors Risk factors for developing a primary inguinal hernia are male gender and old age 9 , 10 , a patent processus vaginalis 7 , systemic connective tissue disorders 13 , 14 , and a low body mass index BMI 10 , Increasing age and low BMI increase the risk of both medial and lateral hernia repairs However, high BMI increases the intraabdominal pressure 16 and also seems to increase the risk of developing a recurrence 4.
The relationship probably has a risk of bias since it is easier to detect an inguinal hernia at lower BMI. Constipation does not appear to be a risk factor Researchers have found an association to prostatic hypertrophy 17 but it is uncertain if it truly is a risk factor 18 , External Risk Factors Smoking increases the risk of recurrence 4 , but it is uncertain if it is a risk factor for developing a primary inguinal hernia 10 , 12 , An explanation to a relationship between smoking and herniation could be increased collagen degradation and decreased synthesis, shown in human fibroblasts High intraabdominal pressure is also proposed to be a risk factor A database study on 1.
Intraabdominal pressure increases when coughing, jumping, etc. For medial hernias, which lack a preformed defect, herniation was unaffected by increased cumulative work exposure 11 , Suction drainages were placed subcutaneous plane. During the early postoperative period no complications occurred.
Inguinal Hernias: Diagnosis and Management
Intensive care treatment was not necessary. No impairment of respiration or oxygenation was registered.
We discharged the patient on postoperative day 8 in an excellent condition. Six months after the operation, a hematocele in localization of the former right testicle was diagnosed. The operative removal of the hematoma and adjacent tissue was performed. After having removed the hematoma, the patient was fully satisfied with the overall postoperative result.
Plastic surgery, in order to reduce the size of the scrotal skin surface, was not performed at any time. Clinically and sonographically no hernia recurrence was registered.
An acceptable cosmetic result prevailed Fig. Furthermore, the patient reported to be sexually active again.
His quality of life had improved notably after the restoration of the giant inguinoscrotal hernia. Different approaches are possible.
Etiology of Inguinal Hernias: A Comprehensive Review
Open abdominal and inguinal approaches are commonly used, if necessary in combination. According to the outer circumstances, ranging from high-end surgery in developed countries to surgery with limited resources in less developed countries, the surgical therapy has to be adapted to achieve the optimal result for the individual patient.
It is necessary to treat inguinoscrotal hernias, since organ perforation can occur, potentially causing peritonitis and sepsis [ 9 , 10 ].
It is proved that early elective operations are associated with less fatal complications than emergency interventions [ 11 ]. Early elective surgical treatment helps to avoid visceral resection, which may bring along the risk of anastomotic leakage and potential prosthetic infection [ 12 , 13 ].
In order to avoid the development of an abdominal compartment syndrome, resulting from a sudden elevation of the intraabdominal pressure following organ reposition, the preoperative administration of progressive pneumoperitoneum therapy was suggested [ 4 ].
Intraperitoneal gas insufflation can be performed continuously or fractionally. Atmospheric air should be preferred to O2 or CO2, since these gasses are absorbed rapidly [ 5 ].
This inguino scrotal swelling was initially reducible, but for the month before presentation it had been irreducible. A week prior to presentation, the patient developed abdominal pain and constipation for which he used self-medication.
He then noticed sloughing of the skin on the left scrotum and faeco-purulent discharge from the wound with symptomatic relief. After this development, the patient's family members brought him to the emergency department of our hospital.
Symptoms and Physical Findings
On examination, his left groin had a visible inguino scrotal swelling with no tenderness and his left scrotum had a wound with faecal discharge. Ultrasonography showed a bowel loop in the left inguinal region and scrotum. The diagnosis was of a scrotal enterocutaneous fistula secondary to spontaneous rupture of an obstructed inguinal hernia.
Emergency exploratory laparotomy was performed. There was no peritoneal contamination.All patients with an inguinal hernia should be referred to a general surgeon because there is always the potential for incarceration or strangulation.
For reconstruction of the abdominal wall, in cases of giant inguinoscrotal hernias, also the direct extension of a midline laparotomy defect using mesh insertion was reported [ 8 ]. The presence of the fistula allowed decompression of the bowel and temporary relief of the intestinal obstruction.
Today, there are many surgical techniques available to repair inguinal hernias.
We discharged the patient on postoperative day 8 in an excellent condition. Furthermore, one should consider that the application of this method requires a prolonged stay in hospital [ 14 ]. The examination should be conducted with a Valsalva maneuver to increase intra-abdominal pressure.
An explanation to a relationship between smoking and herniation could be increased collagen degradation and decreased synthesis, shown in human fibroblasts