Abdominal Wall

Question 1

Principles of management for hernias

Answer 1

Always attempt to reduce to lower the risk of strangulation/obstruction

If the hernia is irreducible, consider elective surgery using the lichtenstein mesh method (gold standard)

If obstructed/strangulated an emergency hartmann’s is performed (end colostomy + rectosigmoiectomy with a residual rectal stump

In infants congenital inguinal hernias are treated with herniotomy and ligation of the processus vaginalis at about the age of 1

Question 2

how should you manage umbilical herniae in children

Answer 2

conservative until the age of 2, if it has not spontaneously reduced by then consider surgical repair (<10% of cases)

Question 3

what is the only way to definitively determine if an inguinal hernia is direct or indirect

Answer 3

in theatre as the inferior epigastric veins provide the boundary, direct passes medial whereas indirect passes lateral to these

Question 4

management of incisional hernia + factors that improve outcome + recurrence risk

Answer 4

Surgical repair involves dissecting out the hernia and then individual closure of each abdominal layer

Repair is usually contraindicated by factors that cause the hernia in the first place

Weight reduction/smoking cessation will increase the likelihood of a successful repair, as well as prophylactic antibiotics

Small incisional hernias have a 2-5% recurrence risk, larger ones have a 10-20% recurrence risk

Question 5

what is the indication for repair with epigastric herniae

Answer 5

pain