Hernia Reduction Techniques

This video demonstrates several hernia reductions. If strangulated bowel is suspected you should not attempt reduction and should instead consult surgery.

For uncomplicated hernias start by administering pain medication or a benzodiazepine and place the patient in a position that will facilitate relaxation of the surrounding muscles and utilize gravity. For inguinal hernias position the patient in 20° of Trendelenburg, and for abdominal hernias place the patient supine. Bending the knees may also help.

Imagine the stalk of the hernia protruding through a fascial defect. Gently push the hernia towards the stalk while providing counter pressure with your other hand. In patients with more adipose tissue it can be difficult to know which direction to push. Imagine a clock face and start applying pressure at noon. Slowly work your way around the clock until you find give and the hernia reduces. If you have any uncertainty about possible ischemic or necrotic bowel, consider observing the patient with serial exams or obtaining imaging.