Abdominal Hernias Chair of Faculty and Hospital Surgery Tashkent Medical Academy

C. Galen( y.) Founder of experimental physiology, anatomy, surgery. Till 14 th century his works remained the only literature devoted to herniology. «I leaded many surgeons, who didn’t know anatomy, to protect them from shame»

C. Celsus (1 century) Was the first who used the term «HERNIOS». Was the first who used the method of transluminal diagnostic to differentiate hernias from hydrocele.

From the history of herniology.

Herniotomy

Conservative treatment (XI century)

Albunasis (16-17 century) «Make the incision above the hernia. Separate the surrounding tissues. Open the suc. Pull inside the inner organ. Then restore the abdominal wall.»

Littre A. (1770) Cooper A.G. (1804) Hasselbachii F. (1814) Roux F. (1830) Poupart M. (1705) Lister V. (1865)

E. Bassini( )

S.I. Spasokukotskiy( )

S.P.Fedorov ( ) S.S.Yudin ( )

T.Bilrot( ) If it would be possible to make the artificial tissue, the problem of hernias would be solved.

K.D. Toskin ( ) McVey ( )

A hernia is a protrusion of visceral contents through the abdominal wall. There are two key components of a hernia. The first is the defect itself, and the second component is the hernia sac, which is a protrusion of peritoneum through the defect. Fatty tissue Intestine Gate Parietal layer Eventeration – going out the organs without parietal peritoneum through the damaged abdominal wall under the skin (subcutaneous eventration) or outside (external eventration).

1 - peritoneum; 2 - fascia transversalis; 3 - Sac 4 – intestinal wall. Sliding hernia – hernia where one side of the hernial sac is an organ partially covered by peritoneum (urine- bladder, ascending and descending colon).

Hernial elements 1 – gates 2 – content 3 – sac 4 – layers

Frequency of hernia Till 1 year years60 and elder

Frequency of hernia by localization

Ethiology Ethiology Local general Anatomical stucture Predisposing Producing the inguinal canal, through which in men pass the spermatic cord, the femoral canal through which the femoral vessels pass, the navel, and the white line of the abdomen, where the muscles have free spacesthe inguinal canal, through which in men pass the spermatic cord, the femoral canal through which the femoral vessels pass, the navel, and the white line of the abdomen, where the muscles have free spaces

Predisponsing factors Heredity; Heredity; Age Age Sex; Sex; Quick body loss Quick body loss Pregnancies; Pregnancies; Traumas; Traumas; Neural paralysis. Neural paralysis.

Risk factors Increasing of the abdominal pressure 1.Constipations 2.Cough 3.Physical activity 4.Labor 5.Difficulty in urination

Classifications of hernia congenital external internal acquired By origin distinguish By anatomical localization femoral umbilical inguinal Line alba By clinical manifestation Non complicated complicated

Complaints Presence of hernia Presence of hernia Pain, discomfort Pain, discomfort Seldom: constipation, vomiting, bloting Seldom: constipation, vomiting, bloting

Special methods of diagnostic Cough symptom- when patient coughing the finger exploring the feels tremors bulge peritoneum and adjacent organs Cough symptom- when patient coughing the finger exploring the feels tremors bulge peritoneum and adjacent organs

Treatment Conservative - bandage Surgical At small children If there are contraindications Heavy comorbidities

Negative moments of pressing bandage Atrophy Atrophy Adhesions Adhesions Hernias gates increasing Hernias gates increasing Skin maceration Skin maceration Inconvenience Inconvenience

Stages of operation Incision Incision Separation of sac Separation of sac Separation of hernia gate Separation of hernia gate Opening of sac Opening of sac Herniotomy Herniotomy Hernioplasty Hernioplasty

Incision

Methods 1- By Sapejko 2- By Mayo 3- By Lexer

Separating of sac

Opening of hernial gates

Separation of hernial sac

Removing of the hernial sac

Sliding hernia If you do not know the anatomical features of the sliding hernia during surgery you can open the intestinal wall or the wall of urinary bladder instead of hernial sac

Hernioplasty

Lichtenstein’s operation

Hernioplasty by Trabuco

Laparoscopic herniotomy

Robot Da-Vinci

Role of General Practitioner Sanitary and prophylactic work with groups of risk Sanitary and prophylactic work with groups of risk Healthy way of life. Healthy way of life. Treatment of obesity Treatment of obesity Right choice for physical work. Right choice for physical work. Early diagnostic Early diagnostic