HERNIOTOMY

Oleh: FENDY NUGROHO

 Herniotomy

 Herniotomy : Leher kantung yang terpaku,

diikat dan kemudian kantung hernia dipotong.
 TYPES OF HERNIA

Inguinal hernia
Femoral hernia
Incisional hernia
Umbilical hernia
Paraumbilical hernia
Hiatus hernia
Spigelian hernia
Strangulated hernia
Obturator hernia
Epigastric hernia
 80% Inguinal Hernia
 Bayi dan anak-anak  congenital hernia.
 Dewasa muda dengan otot inguinal yang
sangat baik.
 Insisi: ½ inci di atas dan sejajar dengan
medial cincin inguinal hampir di saluran
inguinal.
Cause: raised intra abdominal
pressure
Mengangkat beban berat
Latihan berat
Whooping cough (Batuk rejan) di masa
kecil
Obstruksi uretra mengejan pada saat
berkemih
Vomiting
Constipation
 Assessment

History – vomiting, intestinal obstruction, lump,

abdominal distension.
Past surgical history
O/O: local :
 Redness + around hernia
 Swelling
 Skin changes
 Lump
 Effect of coughing
 O/P:
O/E:
 Temperature  Pain

 Tenderness  ROM

 Swelling  MMT

 ADL

On percussion:
 Resonant : intestine
 Dull : omentum,
extraperitoneal fatty
tissue
 Physiotherapy management

AIM
 Increase strength of abdominal muscles
 Proper positioning
 Soft tissue healing- 3-4 weeks, muscles – 7-12
days
Pre operative
Chest physiotherapy
Exercise tolerance test
Improve muscle strength
 POST-OPERATIVE MANAGEMENT

Day 0
• Assessment
• Operation notes
• Level of consciousness
(tingkat kesadaran)
• Level of pain
• Analgesia
• Wound site
• Attachments

• Position of patient

• Auscultation

• Homan’s sign

Treatment
Lebih menekankan pada fungsi pernapasan dan
peredaran darah. Pasien harus mengulangi latihan
setiap jam.
 Day 1
• Mobility exercise: rolling to side lying, pushing

up to sitting position.

• Deep breathing exercises every hourly.

• Supported coughing.

• Calf stretch and ankle pumps every quarter

hourly.
• Gerakan ekstremitas atas unilateral untuk
meningkatkan ekspansi dada setiap jam.
• Pijat perut ke arah usus besar membantu

mengurangi nyeri perut karena 'gas'.

 Day 2
Encourage walking for short distance with
assistance.

Continuation of day 1 exercises.

Add pelvic and abdominal exercises.
 Day 3 onwards

Longer periods of sitting out and walking.

Continuation of previous exercises.

Pelvic floor exercises if there is no catheter in
situ. 5 repetition of five sec hold.

Posture and back care advises.

 Femoral hernia…

Lower limb mobility is more important.

Wear inguinal belt
Squatting, weight lifting after 3 months
 Complications…

DURING OPERATION
 Injury to vein or nerve
 Urinary bladder

 Inferior epigastric vessels

 Contents of sac

EARLY POST OPERATIVE

 Retentionof urine
 Inflammation of spermatic cord, scrotum

 Wound infection
LATE POST OPERATIVE

Reccurance
Neurologic pain due to involvement of
ilioinguinal nerve in suture
Painful scar
Atrophy of testis due to testicular nerve due to
compression of spermatic cord
Epidermal cyst
Thank you