Groin Hernia
Hernia of the inguinal and femoral areas
Inguinal: above the abdominocrual crease (>95% male) - direct or indirect
Femoral: below the abdominocrural crease (97% female)
Ventral Hernia
Present on the anterior abdominal wall at any point other than the groin
May present along the linea alba (epigastric, umbilical, and hypogastric) or at the semilunar lines (spigelian hernia)
Incisional Hernia
Hernias at the site of previous surgeries and at stomal site
Diphragmatic Hernia
Hernia in the diaphragm, usually at the esophageal hiatus
Reducible Hernia
Manual manipulation can return the hernia contents to the abdominal cavity
Irreducible Hernia or Incarcerated Hernia
Manual manipulation cannot return the hernia contents to the abdominal cavity
Strangulated Hernia
Hernia with luminal viscera entrapment that compromises the vascularity of the viscera
Hernia
A protrusion of a viscous through an opening in the wall of the cavity in which it is contained. The hernial orifice is the defect in the abdominal wall and the hernia sac is the outpouching of the peritoneum
External Hernia
If it protrudes through the abdominal wall
Interparietal Hernia
If the hernia is within the visceral cavity
Richters Hernia
Incarcerated or strangulated bowel spontaneously reduces and the subsequent gangrenous portion of bowel may be overlooked during hernia repair
Sliding
Abdominal viscera forms forms part of the hernia sac
Direct
Inguinal hernia
aquired type
presents with hesselbachs triangle (bounded by the inguinal ligament, the inferior epigastric vessels, and lateral border of the rectus abdominis
Indirect
Inguinal hernia
congenital type
follows congenital defects that dilate the internal inguinal ring and pass through the deep inguinal ring to the scrotum
hernia sac is generally confined to the spermatic cord and the posterior inguinal wall remains intact
Pantaloon
Both direct and indirect hernias are present
Femoral Hernia
More common in females than males
the fossa ovalis is the passageway for the iliopsoas muscle and blood vessels, nerves, and lymphatics that suply the lower extremity. the femoral sheath divided into three compartments and the smallest is the femoral cana
Epigastric
Midline hernias above umbilicus
Hypogastric
Midline hernias below the umbilicus
Umbilcal
In children, usually congenital; often spontaneously close
usually acquired in adults
hernias consist of a peritoneal sac and omentum or abdominal viscera contents protruding through the umbilical ring
Scarpa's Fascia (McVay/cooper ligament)
Membranous sheet attached to iliac crest, linea alba, pubis to the Inguinal (poupart) ligament to the transversalis fascia
Transversalis Fascia
Separates abdominal musculature from preperitoneal fat; continuation of fascia containing the abdominal cavity.
Main focus of inguinal herniation; it is inherently weak, the hernia occurs through a tear in the fascia
Coopers ligament
Periosteum of the pubis
Inguinal Canal
Consists of internal and deep inguinal rings. Internal inguinal ring is located superolateral to the pubic tubercle, and deep inguinal ring is located halfway between symphasis pubis and iliac spine along the abdominocrural crease. The canal is located in
Mesh On McVay
If mesh is used, it is sutured into place; one edge is sutured to the inguinal ligament, the other edge is sutured to the conjoined tendon, the lateral edge is cut into tails to be placed around the spermatic cord and sutured into place
Supplies unique to the McVay
Penrose drain, synthetic mesh, suture or staples, aerobic and anaerobic cultures
Totally Extrapertinoneal Patch (TEP) Hernia Repair
Equipment: 30 degree laparoscope, laparoscopic stapling device, laparoscopic instruments, dissecting balloon, polyproplylene mesh and sutures, loop ligature
Practical Considerations: Surge tech must know how to set up all laparoscopic instruments and may
Pathological Conditions of the Stomach
Gastric ulcer disease: Epigastric pain radiating to the back, pain on ingestion of food, weight loss. Dx: Upper GI series, endoscopy, Bx to rule out malignancy. Treatment: dietary control, medication control, antacids, vagotomy, excision of ulcer.
Gastrit
Laparoscopic Nissen Fundoplication
Instruments: harmonic scalpel, laparoscopic equipment, insufflator, 0& 30degree laparoscopes, liver retarctor, coag hook, grasping forceps, lap ligating clip appliers and clips, trocars, minor instrument set, lap set.
5 trocars are usually placed: ubove u
Gastroduodenostomy (Billroth I)
Antrectomy removes the distal portion of the stomach and the pylorus, reanastomosis is to the duodenum
Gastrojejunostomy (Billroth II)
Antrectomy removes the distal portion of the stomach and pylorus, reanastomosis is to the jejunum
Gastrectomy
Removal of the stomach, total or partial may be performed for other conditions