Abdominal wall surgery

Question 1

What is a hernia?

Answer 1

Protrusion of a viscus or part of a viscus through a defect of the walls of its containing cavity into an abnormal position

Question 2

What are the complications of a hernia?

Answer 2

• incarceration: irreducible hernia, contents trapped
• obstruction: hernia causes a blockage
• strangulation: hernia is non reducible and cuts off the blood supply causing ischaemia

Question 3

What are the management options for a hernia?

Answer 3

• Conservative
• tension free repair: mesh is placed over the defecr and sutured into the muscles and tissues on either side of the defect
• tension repair: suture the muscles and tissues either side of the defect

Question 4

What is an indirect inguinal hernia?

Answer 4

Bowel herniates through the inguinal canal

Question 5

What is a direct inguinal hernia?

Answer 5

Weakness in the abdominal wall at hesselbachs triangle, hernia protrudes directly through the abdominal wall

Question 6

Where is the mid-inguinal point?

Answer 6

Halfway between the ASIS and the pubic symphysis

Question 7

Where is the mid point of the inguinal ligament?

Answer 7

Halfway between the ASIS and the pubic tubercle (where the deep inguinal ring should be)

Question 8

Anterior wall of inguinal canal

Answer 8

Aponeurosis of the external oblique, reinforced by internal oblique laterally

Question 9

Posterior wall of inguinal canal

Answer 9

Transversalis fascia, medial 1/3 is conjoint tendon

Question 10

Superior wall of inguinal canal

Answer 10

Transversus abdominis and internal oblique

Question 11

Floor of inguinal canal

Answer 11

Inguinal ligament

Question 12

What is the contents of the inguinal canal?

Answer 12

• external spermatic fascia
• cremasteric fascia
• internal spematic fascia
• spermatic cord in men : vas deferens, pampiniform plexus
• ilioinguinal nerve
• round ligament in women

Question 13

How can you tell if an inguinal hernia is direct or indirect?

Answer 13

Direct: medial to the vessels, more likely to be acquired, reduced easily

Indirect: lateral to the vessels, higher risk of strangulation, more likely congenital

Question 14

Where is a femoral hernia?

Answer 14

Below and lateral to the pubic tubercle, commonly present as a mass in the upper medial thigh

Question 15

What is the management of femoral hernia?

Answer 15

Herniotomy (ligation and excision of the sac) or Herniorrhaphy (repair the defect)