Page 19 - herina surgery and possible lawsuits

Etiopathology of hernia

The etiopathology of the herrna formation and recurrence after hernia surgery had local as

well as systemic factors. Cooper (1804) identified the transversalis fascia as the last barrier to
groin henna. Hernia development may be because of direct change in the groin tissue or may

be because of rise in the into abdominal pressure working as precipitating factor. Strength of
the abdominal wall was considered to be diminished by congenital deficiency, debility or
aging.[23]
1. Anatomical Factor

Posture of the human have role in development of groin hernias as it develop from the
myopectineal onfice of Fruchaud. In quadruped mammals thigh is flexed forward,

groin structures are not stretched under tension and inguinal canal lies in an upward
direction. The weight of the abdominal contents directed forward and downward, away
from the inguinal canal. Where as in humans upright posture causes the gravitational
stress to pass down to the lower abdommal wall which structurally not designed nor

able to evolve its new role, this was further augment by absence of the posterior rectus
sheath below the arcuate line. The downward direction of the inguinal canal and the
weight of the intra-abdominal content pressmg on its internal opening tend to dilate it

and allow the loos of bowel to enter the canal If these are the factors than it is
surprising that less than 5% of the population develop hernia, it means that causes of
groin hernia is probably multifactonal and one or more factors applying in any

particular case. [47]
Patent processus vaginalis is considered to be the cause of indirect inguinal hernia in infants
and are treated with simple high ligation, but in adults in whom it is patent and treated

with high ligation it result in high rate of recurrence. [47] Epidemiologic evidence has
shown that 20% of men pass into adulthood with a patent processus vaginalis, but less
than 50% develop clinical hernia. In addition, indirect inguinal hernia may appear first
in a man over 40 years of age, indicating that additional etiological factors may have

role. [48]
Shutter mechanism is considered preventive mechanism of the abdomen against extremely
high intra-abdominal pressure in response to coughing, straining, and lifting. The

shutter is produced by descent of the transverses arch and "conjoint" tendon towards
the inguinal ligament, m front of the internal abdominal ting. Contraction of the

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