1. Dr.P.Viswakumar.,M.SAssistant professor,Dept of General surgery,PSGIMSR.

2. The term hernia is derived fromthe Greek word hernios, whichmeans budding.Hernia Protrusion of visceral contentsthrough the Abdominal wall.Two key componentsDefect Hernial Sac 3. Erect Human posture Vulnerability betweenabdominal muscle wall & hard pelvic bones. Passage of various structure from trunk toextremities (Femoral nerve,Iliac vessels andSpermatic cord). So Adult hernia is in part results from weakness ofinner envelope of Abdominal wall (Transversalisfascia). Weakest points Inguinal, Femoral and Umblical. 4. Why ? No disease of human body belonging to theprovince of the surgeon requires in its treatment abetter combination of accurate knowledge withsurgical skill than hernia in all its varities- Sir Astley paston cooper ;1804 5. Layers of Abdominal wall ??- 9 layers1) Skin2) Campers fascia3) Scarpas fascia4) External oblique muscle & aponeurosis.5) Internal oblique muscle & aponeurosis.6) Transverse abdominus & aponeurosis.7) Transversalis fascia8) Preperitoneal fat.9) Peritoneum. 6. Ligament of henle/Falx inguinalis : Lateral vertical expansion of the rectus sheath that insertson the pecten of the pubis. In one-third to one-half of patients and is fused with thetransversus aponeurosis and fascia 7. Conjoint tendon: By definition, the fusion of lower fibers of the internaloblique aponeurosis with similar fibers from theaponeurosis of the transversus abdominis where theyinsert on the pubic tubercle and superior ramus of thepubis. The trouble is that the anatomic configuration thusdescribed is extremely rare (3 5%). The distinction between falx inguinalis andconjoined tendon is one of anatomic nicety andadmittedly of little practical significance in theoperating room provided that the distinction isunderstood. The term conjoined area can be applied correctlyto that region that contains the ligament of Henle 8. Ligament of Gimbernat (Lacunar Ligament): Triangular extension of the inguinal ligament before itsinsertion upon the pubic tubercle. 9. Coopers or Pectineal ligament: The periosteum of the superior ramus of the pubis,strongly reinforced by endoabdominal fascia(transversalis fascia), with more reinforcement by thetransversus abdominis aponeurosis and the iliopubictract mediallyIliopubic tract : Aponeurotic band formed by transversus abdominismuscle and aponeurosis and the transversalisfascia. Begins near the anterior superior iliac spineextends medially to attach to Cooper's ligament 10. The inguinal canal is formed in relation to the relocationof the testis during fetal development. The inguinal canal in adults is an oblique passageapproximately 4 cm long directed inferomedially. The main occupant is the spermatic cord in males andthe round ligament of the uterus in females. The deep (internal) inguinal ring defect in fasciatransversalis. The superficial ring is a split that occurs in the diagonal,otherwise parallel fibers of the external obliqueaponeurosis. The lateral crus attaches to the pubictubercle, and the medial crus attaches to the pubic crest. 11. Anterior wall: external oblique aponeurosis throughout thelength of the canal; its lateral part is reinforced by musclefibers of the internal oblique. Posterior wall: transversalis fascia; its medial part isreinforced by pubic attachments of the internal oblique andtransversus abdominis aponeuroses that frequently merge tovariable extents into a common tendonthe inguinal falx(conjoint tendon)and the reflected inguinal ligament. Roof: laterally by the transversalis fascia, centrally bymusculoaponeurotic arches of the internal oblique andtransversus abdominis, and medially by the medial crus of theexternal oblique aponeurosis. Floor: laterally by the iliopubic tract, centrally by gutter formedby the infolded inguinal ligament, and medially by the lacunarligament. 12. The laparoscopic anatomy of the inguinal area based onMyopectineal orifice of Fruchaud. Superior: Arch of internal oblique muscle and transversusabdominis muscle Lateral: Iliopsoas muscle Medial: Lateral border of rectus muscle and its anteriorlamina Inferior: Pubic pecten 13. Preperitoneal space:Space of Retzius- Retropubic spaceSpace of Bogros Lateral extension of space ofretziusContains inferior epigastric artery 14. Types :Anatomical types: According to Extenti) Bubonoceleii) Incompleteiii) Complete 15. According to its site of Exit :i) Indirect hernia.ii) Direct hernia.Indirect(oblique) Hernia : 80 % of cases Almost all pediatric and women cases comprise thisgroup Often a complete variety Two forms Congenital and AcquiredCongenital1) Congenital vaginal(complete)2) congenital funicularAcquiredDifferentiated from above by as it wontform complete hernia 16. According to its contents:1) Enterocele2) Epiplocele or Omentocele3) CystoceleClinical types:i) Reducibleii) Irreducibleiii) Obstructed or Incarcerated (irreducibility + obstruction)iv) Strangulatedv) Inflammed 17. Rare varieties of Hernia : Hernia-en-glissade or Sliding hernia.Extraperitoneal bowelPart of sac wall 18. Richters hernia 19. Littres hernia 20. Maydls hernia ( Hernia-en-W)Strangulatedintraabdominal partBowel within sac 21. CoughingChronic obstructive pulmonary diseaseObesity Straining Constipation ProstatismPregnancyBirthweight