TEKNIK OPERASI HERNIOTOMI

ANATOMI KANALIS INGUINALIS

Anterior

Aponeurosis M.Obliquus eksternus

abdominis,
Lateral M.Obliquus internus.
Posterior

Base : lateral aponeurosis Transversus

Abdominis muscle and transversalis
fascia.
Medial : aponeurosis of Obliquus
internus muscle
Superior

Roof: Obliquus internus

,Transversus Abdominis
muscle and its aponeurosis.
Inferior

Ligamentum inguinalis
poupart and ligamentum
lacunare Gimbernat
 ETIOL0GY
Patent processus vaginalis
 Management of Congenital
Inguinal Hernia
No
symptom, Non
reduces reducible
easily

Elective Strangulatio
If ,Risk (+)*
repair n

<1 year, or Contralateral

>1 year No Yes
ovary (+) in sac groin exp.

Repair as soon Sedate**,

Repair as soon Emergency
as possible manual
as convenient repair
within 4 weeks reduction

Non
Successful
succesful
recuction
reduction
*) increased anaesthetic risk, LBW, premature, increased
abd. fluid, difficult transport
**) Diazepam dose (per rectal) : Repair after Emergency
48 hours repair
Reduksi
Manual
 Perioperative Preparation
Elective Surgery Emergency Surgery

NPO
Laboratory Examination
Bowel Decompression

Chest X -Ray Fluid resuscitation

Electrolyte and Acid Base
Correction
Ultrasound Antibiotic if Peritonitis is present
Laboratory Examination
Eliminate other infection
before operation Chest X-Ray
TEKNIK OPERASI

A 1.5-cm
transverse
inguinal skin
crease incision is
placed above
and lateral to the
pubic tubercle.
The subcutaneous fat and the fascia of Scarpa (which is
surprisingly dense in infants) are opened, grasping them
with small-toothed Adson forceps. Using blunt scissors or
cautery, the external oblique aponeurosis and external ring
are exposed. The external inguinal ring is not opened
except in older children and adolescents.
The external spermatic fascia and cremaster are
separated
along the length of the cord by blunt dissection.
The hernial sac is seen and gently separated from
the vas and vessels. A haemostat is placed on
the fundus of the sac.
 The sac is divided between the clamps and twisted so
as to reduce
its content into the abdominal cavity transfixed with
a 4/0
stitch at the level of internal ring
In the case of hydrocele, the distal part of the sac is
widely
slit allowing adequate drainage of fluid.
 Subcutaneous tissues are approximated using two or

three 4/0 absorbable interrupted stitches and the

skin is
closed with a 5/0 absorbable continuous subcuticular
suture.
At the end of the operation, the testis, always
tractioned
Terima Kasih