INGUINAL HERNIA

Presented by-

DR. AMAR RATHOD

M.S.(Ayurved)
 HERNIA = ANTRA VRIDDHVI
Hernia / Antra Vriddhi is being discussed in Sushrut-Samhita Nidan
sthan chapter 12 & Chikitsa sthan chapter 19.

Type of Scrotal Swelling=Vrishan Kosh Vriddhi (According to Sushrut)

* Vaataj = Tortion of testes / Strangulated Hernia

* Pittaj = Abscess / Pyocele
* Kaphaj = ? Tumor of testes e.g.Seminoma
* Raktaj = Haematocele
* Medaj = Filarial swelling / Lypoma
* Mutraj = Hydrocele
* Aantraj = Inguinal hernia
Scrotal Swelling= Vrishan kosh vriddhi
Definition:
ANTRASYA SWA STHANAT ANYATRA GAMANEN YA UTSEDHRUPO VRIDDI: SA
---ANTRA VRIDDHI.

Samprapti :
- Adh: prakupito anyatamo hi dosh:
phalkoshvahini abhiprapadya dhamani: phalkoshyo vriddhim janayati, tam vriddhim
iti aachachyati.

NOTE:- Charak renames Vriddhi as –BRADHNA.

Hetu-Etiology: =VAAT PRAKOP

- Bhar haran,Balvad vigrah, Vriksh prapatan adibhi: Aayas visheshe: Vayu: Abhi-
pravridh: Prakupita: ch Sthulaantrasyet: Asya ch Ekdesham Vigunan Aaday Adho
Gatva Vankshan-sandhim Upetya Granthi rupen Sthitva Apratikriyamane ch
Kalantaren Phal-koshm Pravishya Mushkshopham Aapadayati, Aadhmato
Bastirivaatatah Pradirgh: sa Shopho Bhavati, Sa-shabdam Avapiditasch Urdhvam
Upaiti, Vimuktashch Punah Aadhmayate, Tam Antra-vriddhim Asadhyam iti
Achcchyate.
RRRRR
 ANTRA VRIDDHI- PURVA RUP & CHIKITSA

Purva-Rupa: PRODROMAL FEATURES

- Basti Kati Mushk Medhreshu vedana Maarut-nigrah:
Phal-kosh Shophshcheti.

Chikitsa:
- Asadhya = If Complete Desending to Scrotum.
- Dahan karm= In Bubonocele- Dahan with semilunar
Shalaka ( Pali) at Inguinal region(? To achieve
local Fibrosis).Also Dahet Anga Viparyayat.
- Sira Vedh =At opposite side of affected area from the
temporal region upto end of Ext. Pinnae.
HERNIA
 Defination-It is defined as abnormal protrusion of whole or a
part of a viscus through an abnormal opening in the wall of the
cavity which contains it.

 Common external hernia

1. Inguinal-73%
2. Femoral-17%
3. Umbilical-8.5%
4. incisional
5. Other-1.5%
 Epigasrtic
 Lumber
 Obturator
 Gluteal
 AETIOLOGY
Mainnly two factors:
1) Weakness of the abdominal musculature
 Congenital-persistent proccessus vaginalis
-patent canal of Nuck
-incomplete obliteration of umbilicus.

 Acquired-excessive fat
-repeated pregnancy.
-surgical incision.

2) Increased abdominal pressure- whooping couhg in child

Chronic couhg in T.B.,BronchitiesEnlarged
prostat,Straining ,Urethral stricture
Persistent vometting
Repeated pregnancy
constipation
PATHOLOGY
Sac-pouch of peritoneum Parts a)mouth b)neck c)body d)fundus

Content of sac-when contain is

-Omentum-omentocele
-Loop of intestine-enterocele
-Circumference of intestine-Richters hernia
-Caecum,pelvic colon or urinary bladder-sliding hernia
-Meckles diverticulum-Litters hernia
Retrograde strangulation.two loop of intestine in W shape.
-Overy,fallopian tube
-Fluid.

Covering of sac-layers of the a bdominal wall i.e.skin,muscle of

abdomen
 classification
1. Reducible 1.congenital
2. Irreducible 2.Acquired
3. Obstructed
4. Strangulated
5. Inflamed.
Other hernia-
 Enterocele
 Omentocele
 Entero-omentocele
 cystocele
INGUINAL HERNIA
 Defination-
An inguinal hernia is the protrusion of part of the content of
the abdomen through the region of the abdominal wall
 Types-DIRECT
INDIRECT
 Inguinal canal
 Deep inguinal ring
 Superficial in
 guinal ring
 Boundaries of inguinal canal
Ant-skin,sup.fasica,extrnal and Internal aponeurosis
Post-fascia transversalis,conjoined tendon,reflected part of

inguinal ligament
Above-conjoined tendon
Floor-inguinal ligament and fascia transeversalis.
Content of inguinal canal

 Ilioinguinal nerve
 Spermatic cord
 Round ligament

 Hesselbachs trangle
 Mechanisums which prevent hernia(inguinal)
DIRECT and INDIRECT(oblique )inguinal hernia

INDIRECT HERNIA

 Abdominal contain enter inguinal canal through deep inguinal

ring
 More common than direct hernia
 Partialy or complet processus veginalis
 More common on right side.
 Males are more affected.
 Comon in children and young age.
 Mostly complet hernia and pyriform in shape
 Descend obliquely downwards and medialy
 It dose not reduce itself.
 Cough Imples-index finger
 Finger invagination-tip of finger
 Ring occlusion-positive
Types (indirect hernia)

 According to extension of contain

 Bubonocele
 Funicular
 Complete or vaginal or scrotal
DIRECT HERNIA
 Protrudes through post wall of the inguinal canal i.e.through
hesselbachs trangle
 Behind/belove/above to spermatic cord.
 Rare hernia
 Usually bilateral
 Elderly individuals affected
 Not seen in females
 Always incomplet,sperical
 Automaticaly reduced
 Forward bulge
 Cough impulse-at middle finger
 Finger invagination-at pulp of finger
 Ring occlusion-:negative
Clinical features
• Age
• Occupation
• Symptoms
-pain
-Lump
-Systemic symptoms
-Past history
Clinical test
1. Position and extend
2. To get above swelling
3. Consistency
4. Couhg impulse test
5. Reducibility (taxis)
6. Ring invagination
7. Ring occlusion test
8. Ziemans technique
DIFERENTIAL DIAGNOSIS
 ENCYSTED HYDROCELE OF CORD
 VARICOCELE
 FUNICULITIES
 LIPOMA OF CORD
 INFLAMMATIRY THIKNING OF CORD
 TORSION OF TESTIS
 LYMPH VARIX
 FEMORAL ANEURYSM
 SURGERY
Herniotomy-sac transfixed,ligated and excised
indication: children and infent
Herniorrhaphy - herniotomy+post.wall repair
indication :all indirect hernia except in children. adult patient.
Hernioplasty-herniotomy +post.wall repair byfilling the gap between
conjoined tendon and inguinal ligament by
a)autogenous material-e.g.skin,strip of fascia lata,ext.obl.apponeurosis
b)heterogenous material-e.g.prolele.stainless steel, Polypropylene
mesh
indication:all direct hernia
-all recurrent hernia
-patient with strenuous job,BPH,Bronchities
Procedure-
A. Bassinis repair
B. Shouldice repair
C. Keels repair
D. Laparoscopic repair
TREATMENT
Surgery is only permanent treatment
 Conservative-
Indication-severe general ill health
-with short life expectency
-Who refuse for surgery
 Truss
indication-Who refuse surgery
-Patient with systemic disorders
- children
contraindication-
-irreducible hernia
-patient with chronic bronchities
hernia with undescended testis
heria with hugh hydrocele
whene patient is not intelligent
Method of use-lying position
In spite of hernia truss chance ofstrangulation remain same.