Groin Hernia Examination Dr. Jignesh Gandhi and Dr. Vivek Bindal

Описание

The anatomic arrangement of muscular and fascial layers in the lower abdomen makes this area a site of potential weakness with possible development of inguinal hernias. Passage through this region by the vas deferens and spermatic vessels in the male and by the round ligament in the female makes the area more vulnerable to hernia protrusions. Inguinal or groin hernias may be congenital, exiting along the spermatic cord or round ligament as "indirect hernias," or may occur due to weakness of the transversalis fascia, producing "direct hernias." Defects medial to the femoral vein as it passes beneath the inguinal ligament allow for the development of femoral hernias. Approximately 80% of all inguinal hernias occur in males, whereas 85% of all femoral hernias occur in females. Examination of the inguinal region in both men and women is best performed with the patient standing and the physician seated on a stool facing the patient. Observation of the groin area in oblique light with the patient relaxed and then actively coughing may reveal a bulge or an abnormal motion. Scrotal masses may also be noted by inspection and palpation. Carefully observe whether any bulge noted is above (inguinal hernia) or below (femoral hernia) the inguinal ligament crease. The examiner should then stand to the side of the patient with the fingers lightly applied to the groin, the left hand on the patient's left side and the right hand on the patient's right side. With the fingers placed over the femoral region, the external inguinal ring, and the internal ring, have the patient cough. A palpable bulge or impulse located in any one of these areas may indicate a hernia. The examiner should then return to the sitting position. In the male, the scrotum on each side is inverted with the examining index finger entering the inguinal canal along the course of the cord structures. The size of the external ring can be ascertained by palpating just lateral to the pubic tubercle. Again with the patient coughing, hernia bulges can be felt either against the side of the examining finger (direct hernia) or at the tip of the finger as it approaches the internal ring (indirect hernia). Large, indirect hernias may extend all the way into the scrotum, giving the gross appearance of a hydrocele. Transillumination of the scrotal contents in a darkened room will aid in differentiating a hydrocele from an intrascrotal indirect inguinal hernia.


Dr. Jignesh Gandhi
Consultant General Surgery and Laparoscopic Surgery with Hiranandani Vashi (A Fortis Network Hospital) Navi Mumbai, Former Associate Professor and Unit Head at KEM Hospital, Mumbai. He is a great surgeon and Hernial repairs are very close to his heart.

Dr. Jignesh Gandhi has over 23 years of work experience of which he has 15 years of experience as a General Surgeon. In the last 15 years, Dr. Jignesh Gandhi has performed more than 100 Laparoscopic Inguinal Hernia Repairs (TE
P technique). He has performed over 100 Laparoscopic Ventral Hernia Repairs and over 500 Inguinal and Open Ventral hernia Repairs. He has also performed Composite Separation Technique for Large Ventral Hernia: Open /Endoscopic.
MBBS and MS Surgery (Gold Medalist) from Shivaji University and DNB, FMAS.
He has co-authored a book titled "Hernia: What can you do about it" besides many other publications.

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DISCLAIMER: Do NOT perform any examination or procedure on patients based purely upon the content of these videos. The content is intended as educational content for health care professionals and students.

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