A Study of Presentation and Management of Complicated Groin Hernias in Adults

Larif, A (2006) A Study of Presentation and Management of Complicated Groin Hernias in Adults. Masters thesis, Thanjavur Medical College, Thanjavur.


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INTRODUCTION: A hernia is defined as the abnormal protrusion of a viscus or tissue through a normal or abnormal aperture. Abdominal wall hernias of the groin include inguinal, femoral and obturator Hernias. Groin Hernias are the most common type of Hernias. Several risk factors have been implicated in the development of groin hernias, including obesity, chronic cough, prostatic enlargement, pregnancy and perhaps most importantly aging, which studies suggest contributes significantly to the breakdown of tissues resulting in the development of some groin hernias. Coughing (or) severe straining as occurs with constipation (or) prostatism frequently precipitates the clinical appearance of the hernia. Most groin hernias are clinically important and should be repaired electively, before they begin to enlarge. Any sudden increase in the size of the mass suggests incarceration or the development of a sliding component. The risks of delaying surgery can be considerable, with the most important concern being the chance of developing complications like incarceration / irreducibility, obstruction and fatal strangulation of hernia contents. If this occurs emergency surgency is inevitable, regardless of the patient’s medical status, comorbid medical conditions or concomitant medications including the use of anticoagulants. The mortality rate in a strangulated Hernia is related directly to the length of time of strangulation and the age of the patient. Our study is intended to have a close look at the clinical presentation of the groin hernias which have proceeded on to complications and the best possible way of successfully managing the case with a background aim of preventing the recurrence of the disease. AIMS AND OBJECTIVES Aims of this study are to know the following: 1. The incidence of Groin hernias presenting with complications, 2. The contribution of obstructed groin hernias to the incidence of intestinal obstruction, 3. The modes of clinical presentation of complicated Groin Hernias, 4. The ideal way of managing a complicated Groin Hernia, 5. Peroperative complications, if any, 6. Ideal method of Hernia Repair, 7. Incidence of Postoperative complications, if any, 8. Follow up of the cases. MATERIALS AND METHODS: The clinical material for this study consists of 50 cases who were admitted and operated for complicated groin Hernia in various surgical units in Thanjavur Medical College during the period February 2005 to February 2006. The patients under study were admitted from casualty with complaint of a groin swelling and associated features of its complication. Those patients who were admitted to have a irreducible hernia initially but become reducible on performing the maneuver of ‘Taxis’ were excluded from the study. In the admission ward, useful history regarding the duration of swelling, duration of irreducibility, history suggestive of obstructive and systemic disturbances were carefully ilicited from the patients (or) their attenders. If the swelling was recurrent, history about the previous operative procedure was ascertained. Enquiries were made about the co-morbid medical illness and about personal habits. The patients vitals were recorded with emphasis on mental status and degree of dehydration. Examination of the groin swelling carried out in detail and subsequent abdominal examination to rule out obstruction and peritonitis. The patients were thoroughly screened for any predisposing factors viz. per rectal examination for stricture, prostatic enlargement (or) growth; abdomen examn. for ascites; Respiratory system examination for chronic Respiratory Tract infection. CONCLUSION: 1. The major complications of groin hernia in our study included irreducibility, obstruction and strangulation. 2. Obstructed groin hernia remains the most common cause of small intestinal obstruction, admitted in emergency department. 3. Most of the complicated groin hernias occur in old aged people. Males out number female in overall incidence. Femoral Hernia is commoner in females. 4. Primary indirect Inguinal Hernia were the most common type of hernia in the study. 5. Right sided Hernias are more common than left regardless of the type of Hernia. 6. Obstruction of the bowel in the hernial sac is the most commonly presented complication. 7. Neck of the hernial sac was the most common constricting agent causing complication. 8. Ileal loops were the most common content of the hernial sac. 9. Initial resuscitation was instituted in all cases of strangulation which helped in smooth preoperative course and smoother postoperative recovery.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Presentation ; Management ; Complicated Groin Hernias ; Adults.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 14 May 2018 15:09
Last Modified: 14 May 2018 15:09
URI: http://repository-tnmgrmu.ac.in/id/eprint/7823

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