Hernias

• What is a hernia?

  Protrusion of an organ through a cavity that usually contains it
• What is incarceration?

  Tissue herniates out & becomes stuck

  Unable to be reduced (irreducible)

  Can lead to obstruction & strangulation
• What is obstruction (hernia)?

  Hernia causes blockage in the passage of faeces through the bowel

  Presents with vomiting, generalised abdo pain & absolute constipation (no faeces or flatus)
• What is the difference between direct & indirect inguinal hernias?

  Indirect

  • hernia through inguinal canal
  • males = into scrotum, follows spermatic cord
  • females =

  Direct

  • hernia through abdominal wall (Hesselbach's triangle)
• What are the borders of Hesselbach's triangle?

  Rectus abdominis muscle (medial)

  Inferior epigastric vessels (superior/lateral)

  Inguinal ligament (inferior)
• What are the RFs of inguinal hernias?

  Male

  Previous hernia

  Older age

  Chronic cough

  Chronic constipation

  Weak abdo wall

  Smoking
• What are the signs & symptoms of inguinal hernias?

  Visible lump

  Lump can increase in size when straining/coughing

  Heavy feeling/discomfort

  Pain

  Aches OE

  Constipation
• What is a femoral hernia?

  Herniation of abdo contents through femoral canal (below inguinal ligament)

  Significant risk of strangulation
• What are the RFs for femoral hernias?

  Female

  Pregnancy

  Chronic constipation

  Increasing age
• What is the difference in the location of inguinal & femoral hernias?

  Inguinal

  -> above & medial to pubic tubercle

  Femoral

  -> below & lateral to pubic tubercle
• What is the management of groin hernias?

  Asymptomatic inguinal hernia -> conservative management

  Repair

  • elective -> symptomatic inguinal hernia
  • 'soon' -> irreducible inguinal hernias; all femoral hernias
  • emergency -> incarcerated/strangulated hernias
• How can you differentiate between direct & indirect inguinal hernias?

  Reduce hernia & apply pressure to deep inguinal ring (mid point from ASIS to pubic tubercle)

  Ask pts to cough

  • hernia remains reduced -> indirect
  • hernia protrudes -> direct
• Fill in the blanks

  A) Umbilical

  B) Epigastric

  C) Spigelian

  D) Incisional

  E) Inguinal

  F) Femoral

  
• What is a ventral hernia?

  Protrusion of abdominal contents through the anterior abdominal wall
• What are the common locations for hernias?

  Inguinal

  Femoral

  Umbilical

  Hiatus hernia
• What are the RFs for hernias?

  Obesity

  Heavy lifting

  Chronic coughing

  Straining during defecation
• What hernias have a low risk of complications?

  Wide neck hernias
• What is the management of abdo wall hernias?

  Leave hernia alone (if wide neck & pts not good candidates for surgery)

  Tension-free repair (surgery)

  • placing mesh over defect in abdo wall
  • prevents herniation of cavity contents
  • over time, tissues grow into mesh & provide extra support
  • lower recurrence rate
  • comp = chronic pain

  Tension repair (surgery)

  • suture muscles & tissues back together
  • rare
  • high recurrence rate
• What are umbilical hernias? Who are they most common in?

  Protrusion of abdominal contents around umbilicus

  Common in neonates, can resolve spontaneously
• What is a parastomal hernia?

  Bulge or protrusion of the abdominal contents near the stoma site