Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
The Abdomen
Laparotomy and Abdominal Trauma
Abdominal trauma
Acute Abdominal Conditions
Assessment and diagnosis
Intestinal obstruction
Stomac and duodenum
Abdominal Wall Hernia
Groin hernia
Surgical repair of inguinal hernia
Surgical repair of femoral hernia
Surgical treatment of strangulated groin hernia
Surgical repair of umbilical and para-umbilical hernia
Surgical repair of epigastric hernia
Incisional hernia
Urinary Tract and Perineum
The urinary bladder
The male urethra
The perineum
Groin Hernias

An abdominal wall hernia is a protrusion of a viscus or part of a viscus through an abnormal opening in the wall of the abdominal cavity. Inguinal hernia is by far the most common type of hernia in males, accounting for about 70% of all hernias. It is followed in frequency by femoral, umbilical and incisional hernia.

Groin hernias include:

:: Indirect inguinal hernia: a persistence of a congenital peritoneal tract that follows the indirect path of the spermatic cord
:: Direct inguinal hernia: a defect in the floor of the inguinal canal
:: Femoral hernia: not an inguinal hernia, but a defect medial to the femoral sheath.

The neck of an inguinal hernia will be above and medial to the pubic tubercle whereas the neck of a femoral hernia will be below and lateral to the pubic tubercle. Surgery is the only definitive treatment for an inguinal or femoral hernia.

Predisposing factors include:

:: Congenital failure of obliteration of the processus vaginalis in infants (inguinal hernia)
:: Increased intra-abdominal pressure, for example, as a result of chronic cough or straining at micturition
:: Previous surgery for ventral hernia.

A hernia is either:

:: Reducible: the contents of the sac can be completely pushed back into the abdominal cavity
:: Incarcerated: the hernia cannot be completely returned into the abdominal cavity
:: Strangulated: the content of the sac has a compromised blood supply with a consequent risk of gangrene.


Examine the standing patient. The hernia appears as a visible or palpable mass when the patient stands up or coughs.

A hernia is non-tender and is painless unless it is strangulated. Patients with strangulated hernia require emergency surgery. They will complain of pain in the abdomen and the groin where the hernia is located. Many vomit. The hernia is very tender, tense and incarcerated. Make the diagnosis by physical examination.

Preparation for surgery

A possible complication of hernia repair is recurrence caused by wound infection, haematoma or poor technique.

Strangulation is the most dangerous complication of a hernia. Recurrence is the commonest complication of hernia operation.

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  Kep Points  
Inguinal hernia bulges above the inguinal ligament, with the hernia neck above and medial to the pubic tubercle

Femoral hernia bulges below the inguinal ligament in the upper thigh, with the hernia neck below and lateral to the pubic tubercle

Inguinal hernia is most common in males

Femoral hernia, which occurs less frequently than inguinal hernia, is more common in women.