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Management of Inguinal Hernia

Management of Inguinal Hernia. 2018 HMO Teaching By Dr Pith Soh Beh. Definition. Relevant anatomical terms: Hernia Types of Hernia. Definition. Relevant anatomical terms: Hernia Protrusion through an opening (Last Anatomy)

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Management of Inguinal Hernia

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  1. Management of Inguinal Hernia 2018 HMO Teaching By Dr Pith Soh Beh

  2. Definition Relevant anatomical terms: Hernia Types of Hernia

  3. Definition Relevant anatomical terms: Hernia Protrusion through an opening (Last Anatomy) Protrusion of viscera through anatomical boundaries (Washington Handbook of Surgery) Types of Hernia Inguinal umbilical Femoral Hiatus Obturator Lumbar Spigelian incisional

  4. Inguinal Hernia Types of Inguinal Hernia:

  5. Inguinal Hernia Types of Inguinal Hernia: Direct Indirect Richter’s Pantaloon

  6. Inguinal Hernia

  7. Inguinal Hernia

  8. Relevant Anatomy Inguinal canal Boundaries: Superior: Inferior: Posterior: Anterior: Contents Spermatic cord 3 3 3 +1 3 Female?

  9. Relevant Anatomy Inguinal canal Boundaries: Superior: transversalis, transversus abdominis/internal oblique Inferior: rolled edge of inguinal ligament Posterior: transversalis, transversus abdominis/internal oblique Anterior: transversus abdominis/internal oblique, external oblique Contents Spermatic cord 3 arteries (testicular artery, artery to the vas, cremasteric artery) 3 nerves ( genitalfemoral, sympathetics, ilioinguinal*) 3 stuffs (vas, pampiniform plexus, processus vaginalis) + lymphatics 3 layers (external spermatic fascia, cremasteric fascia, internal spermatic fascia) Female? round ligament, ilioinguinal nerve

  10. History and Clinical Exam (1) History: Past Hx / Risk Factors Exam:

  11. History and Clinical Exam (1) History: Lump, pain, vomiting/nausea Past Hx / Risk Factors Previous hernia Heavy lifting Smoker / chronic cough Connective tissue disease, steroid use, Exam: Palpate over suspected hernia site Elicit cough impulse Augment by getting patient to stand up

  12. History and Clinical Exam (2) Relevant anatomical landmarks for inguinal hernia

  13. History and Clinical Exam (2) Relevant anatomical landmarks for inguinal hernia Public tubercle, symphysis Mid-inguinal point, mid point of inguinal ligament

  14. History and Clinical Exam (2) Relevant anatomical landmarks for inguinal hernia Public tubercle, symphysis Mid-inguinal point, mid point of inguinal ligament

  15. Investigations Adjuncts? ECG Urine dipstick Pathology FBE UEC VBG Imaging XRay Ultrasound CT

  16. Management DRABC Symptomatic relieve (pain, nausea) Non-operative Reassurance Avoid trigger (tight undies, completing online manual handling protocol & adhering to it, quit smoking) Surgical management *Should I push it in?* 🤔

  17. Manual Reduction Reducible Irreducible / Incarcerated Obstructed Strangulated

  18. Manual Reduction Reducible 💯 Irreducible / Incarcerated Obstructed Strangulated 🙅

  19. Surgical Management(Hernioplasty) Open Surgery Laparoscopic surgery Principles of surgery Tension repair Tension-free repair

  20. History of Hernia Surgery (open) “Those who fail to learn from history are doomed to repeat it” George Santayana

  21. History of Hernia Surgery (open) Primary Closure repair Bassini McVay Shouldice Tension-free Mesh repair Lichtenstein ? Darnings technique

  22. History of Hernia Surgery (open) BassiniMcVay

  23. History of Hernia Surgery (open) Shouldice Darning

  24. Modern Hernia Surgery Open Lichtenstein Repair

  25. Modern Hernia Surgery Laparoscopic Trans Abdominal Pre-Peritoneal (TAPP) Totally Extra-Peritoneal (TEP)

  26. Modern Hernia Surgery - TEP

  27. Modern Hernia Surgery - TEP

  28. Modern Hernia Surgery - TAPP

  29. Modern Hernia Surgery - TAPP

  30. References Lasts Anatomy Washington Handbook of Surgery

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