How is an abdominal hernia reduced?

Updated: Jul 23, 2019
  • Author: Assar A Rather, MBBS, MD, FACS; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

In attempting hernia reduction, the first step is to provide adequate sedation and analgesia so as to prevent straining or pain. [1, 5, 33] The patient should be relaxed enough that he or she will not increase intra-abdominal pressure or tighten the involved musculature.

The patient should be supine, with a pillow under the knees. For an inguinal hernia, the patient should be placed in a Trendelenburg position of approximately 15-20°. The ipsilateral leg is placed in an externally rotated and flexed position resembling a unilateral frog leg position. A padded cold pack may be applied to the area to reduce swelling and blood flow while appropriate analgesia is established. Ice cooling of an incarcerated hernia is counterproductive.

Simple pressure over the distal sac usually is ineffective, in that the incarcerated viscera are likely to mushroom over the external ring (see the first image below). Instead, two fingers are placed at the edge of the hernial ring, and firm, steady pressure is applied to the side of the hernia contents close to the hernia opening and maintained for several minutes while the hernia is being guided back through the defect (see the second image below).

Hernia content balloons over external ring when re Hernia content balloons over external ring when reduction is attempted.
Hernia can be reduced by medial pressure applied f Hernia can be reduced by medial pressure applied first.

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