Chapter 2. ABDOMINAL HERNIAS

Definition and statistical data
Abdominal hernias - the entrance or possibility of the entrance of the abdominal cavity inner organs through the natural or acquired openings of the abdominal wall, pelvic fundus, diaphragm (muscular-aponeurotic layer) under the outer body coverings or into the adjacent cavities with parietal peritoneum entity preservation.	They are found in 3-4% cases among the whole population. Among all hernias inguinal ones are 73% cases, femoral - 7%, umbilical - 8%, post-operative - 11%. Other kinds of hernias consist about 1%.

ETIOLOGY AND PATHOGENESIS

CLASSIFICATION OF HERNIAS

CLINICAL DIAGNOSTICS

TREATMENT OF NON-COMPLICATED (REDUCIBLE) HERNIAS

INGUINAL HERNIAS

Differentiation of direct and oblique inguinal hernias (according to indirect clinical and anatomical characteristics)
Characteristic	Direct hernia	Oblique hernia
Age	More often old	Young
Localization	More often bilateral	More often unilateral
Form	Rounded (semispherical)	Oval (elongated)
Direction of the cough tremor	Direct	Oblique
Descending into the scrotum	Does not occur	Occurs
Strangulation	Does not occur	Occurs
Origin	Always acquired	May be congenital
Sliding hernia	Occurs	Does not occur
Location of the spermatic cord	Laterally from the hernial sac	Medially from the hernial sac
Reference of the sac's neck to the epigastric vessels	More medial from the vessels	More lateral from the vessels

FEMORAL HERNIAS

UMBILICAL HERNIAS

MIDLINE HERNIAS

POSTOPERATIVE VENTRAL HERNIAS

RARE TYPES OF ABDOMINAL HERNIAS

COMPLICATIONS OF HERNIAS

Intraoperative detection of the strangulated intestine vitality following the strangulating ring cleaving
Signs	Intestine is vital	Intestine is not vital
Hernial water	serous, transparent	turbid with odor
The color of the intestine	may be cyanotic, but after strangulation liquidation the normal color is quickly restored.	black-green or gray, after the strangulation liquidation the normal color is not restored.
Wall tonus	quickly restored after strangulation liquidation	after strangulation liquidation the intestine remains flabby
Peristalsis	quickly restored	absent
Pulsation of the vessels	preserved	absent
Limits of the resection of the dead intestinal loop: towards the efferent loop - 20 cm, towards the afferent side - 40 cm from the border with the intact intestine due to its overextension and intestinal wall dystrophy. In the hernial sac phlegmon medial laparotomy is performed. At the hernial sac phlegmon is performed laparotomy near hernia, resection of intestine, necrectomy.