Anterior Abdominal Wall (Hernias) Flashcards
Def of Hernia
protrusion of a viscus or other structure beyond normal coverings of cavity in which
it is contained
Elements of hernia
sac, contents and a neck
Complications of hernias
: incarceration, intestinal obstructions, strangulation
What is Taxis?
: non-operative treatment of intestinal obstruction = manual reposition
can be done if reducible and no signs of strangulation must be done within 2 hrs
Def of Strangulated hernia
: irreducible hernia with ischaemic or necrotic contents
Def of Recurrent Hernia
Hernia recurring after previous hernia repair
Types of anterior abdominal wall hernias
groin (inguinal*, femoral), umbillical, epigastric, spigellian and incisional
- can be direct or indirect
Anatomy of inguinal canal
-anterior wall (aponeurosis of external oblique m)
-posterior wall (transverse fascia)
-superior wall (arching fibres of internal oblique m and traverse
abdominis m)
-inferior wall (in-rolled edge of inguinal ligament)
-internal ring (round lig or
spermatic cord emerge through transverse fascia)
-external inguinal ring (V-shaped opening of anterior wall immediately superior to pubic tubercle)
Anatomy of femoral canal
Anterior wall (inguinal ligament)
posterior wall (iliopectineal lig),
medial wall (lacunar part of inguinal ligament),
lateral wall (femoral vein)
Most common type of anterior abdominal wall hernia:
inguinal hernia, 80% of them
Contents of the inguinal canal
Males: spermatic cord and the genital branch of the genito-femoral nerve
Females: round ligament of the uterus and the ilioinguinal nerve
Types of inguinal hernias:
direct (sac doesn’t protrude through the inguinal canal),
indirect (sac protrudes through inguinal canal)
Def of Epigastric hernia
: protrusion of preperitoneal fat through fascial defect in the decussating
fibres of supraumbilical portion of linea alba, peritoneal sac may accompany fat through the
defect, containing omentum or rarely bowel
Def of Spigelian Hernia
: interparietal hernia in the line of linea semilunaris* (lateral margin of rectus
sheath, runs from tip of 9th costal cartilage to pubic crest)
*semilunar line - curved teendinous intersection found between lateral wall of rectus abdominus and external obliques
Def of Incisional Hernia
occurs through the wound (cicatrix) of a previous operation (postoperative
complication
What are the types of adult umbilical hernias? What is the difference between them?
True umbilical hernia: protrusion through umbilical scar tissue everting the umbilicus
Para-umbilical Hernia: develops at the superior aspect between the umbilical vein and the upper margin of the umbilical ring (weakest area of the umbilical scar). The hernia displaces the scar which lies below and slightly to one side.
Para-umbilical are more common than true.
Def of Richter’s Hernia
contains part of the circumference of bowel wall, which can cause strangulation without obstruction
Def of Maydl’s Hernia
contains two adjacent loops of bowel, segment between loops may be strangulated
Def of Littre’s Hernia
hernia contains a Meckel’s diverticulum
How can you distinguish femoral from inguinal hernia?
The upper medial border of a femoral hernia is always below and
lateral to the pubic tubercle.
Why should you never try manual reposition in strangulated umbilical hernias in adults?
Manual repositioning (taxis) in strangulated adult umbilical
hernia may shift strangulated bowel loop from one to other
loculations (loculated nature of the hernia sac!) = false-positive
success of taxis.
62-year-old man is in the operating room undergoing an open left inguinal hernia repair. A large indirect sliding hernia is found, during the dissections, the sigmoid colon is inadvertently injured. The colotomy is easily repaired with sutures. Which of the following
hernia repairs should be used in this situation?
Bassini Repair
The Bassini technique for inguinal hernia repair involves suturing the transversalis fascia and the conjoined tendon to the inguinal ligament behind the spermatic cord with monofilament nonabsorbable suture. It also involves the Tanner slide, a vertical relaxing incision in the anterior rectus sheath intended to prevent tension.
Which type of hernia gets incarcerated most often and should be repaired as soon as it is diagnosed?
Femoral Hernia
The inguinal canal contains in men?
Spermatic cord
