Ch.40 Abdominal Hernias

Question 1

Difference between inguinal rupture and ruptured inguinal hernia?

Answer 1

In an inguinal rupture the viscera protrude through a rent in the peritoneum adjacent to the vaginal ring and lie outside the vaginal process.
In a ruptured inguinal hernia, viscera enters the subcutaneous tissue through a rent in the vaginal process.

Question 2

The deep inguinal ring is formed by

Answer 2

Cranial - Caudal edge of internal abdominal oblique

Ventromedial - Rectus abdominis m. and prepubic tendon

Caudolateral - Inguinal lig.

Question 3

By what age should a small manually reducible inguinal hernia resolve in foals.

Answer 3

6 months

Question 4

What fraction of acquired inguinal hernias affect the left side?

Answer 4

2/3

Question 5

What is the reported success rate of manual reduction of acquired inguinal hernia?

Answer 5

82.5%

Question 6

What is the reported % of horses requiring small intestine resection following successful manual reduction of acquired inguinal hernia?

Answer 6

12.5%

Question 7

What direction should the vaginal ring be incised to facilitate reduction of herniated intestine and why?

Answer 7

Craniolateral to avoid the caudal epigastric

Question 8

What size vaginal ring necessitates closure?

Answer 8

2 fingers or more

Question 9

What size mesh in used in vaginal ring closure?

Answer 9

8 x 6cm

Question 10

How large a flap should be made when closing the vaginal ring with a peritoneal flap?

Answer 10

6x10cm

Question 11

What size endohernia staples are used in the peritoneal flap approach to closure of the vagina ring

Answer 11

4.8mm

Question 12

Coverage of which aspect of the vaginal ring is critical to prevent herniation

Answer 12

Caudal

Question 13

Hernias characterized by incarceration of only the anti mesenteric aspect of the intestine

Answer 13

Richters or Parietal

Question 14

Only considered a true hernia if

Answer 14

Protrudes through a normal aperture

Question 15

Protrusion of viscera through an acquired opening is called a

Answer 15

False hernia or rupture

Question 16

Diff between true and false hernia

Answer 16

True
- viscera protrudes through a normal aperture
-sac is lined with peritoneum

False
- Acquired opening
- Not lined with peritoneum

Question 17

Which gender are congenital umbilical hernias most prevalent in

Answer 17

Female

Question 18

In which breeds are congenital umbilical hernia most prevalent

Answer 18

TB AQH

Question 19

Umbilical hernias developing between which weeks are less likely to spontaneously resolve

Answer 19

5-8weeks

Question 20

Umbilical hernias of what size may resolve spontaneously by the time the foal reaches 6-12mo

Answer 20

3cm or less

Question 21

Elastrator rings can be used for hernias up to what size

Answer 21

8cm

Question 22

Premature dislodgement of the hernial clamp may result in

Answer 22

Evisceration

Question 23

Activity following herniorraphy consists of

Answer 23

30-60 days stall confinement with hand walking followed by 30 easy small paddock turnout

Question 24

When does acute total dehiscence usually occur

Answer 24

In recovery

Question 25

Delayed total disruption of the ventral incision usually occurs within what timeframe

Answer 25

3-8 days

Question 26

What is used for secondary closure of a dehisced abdomen? Suture, pattern, distance between sutures and edges

Answer 26

18-22 gauge stainless steel wire Through and through interrupted vertical mattress 2.5cm apart Far - 5cm from edge of wound Near - 2.5cm from edge of wound

Question 27

When wiring an abdomen post dehiscence, which layers should the wire engage

Answer 27

Near - all layers minus the retroperitoneal fat and peritoneum or just skin and subcutaneous Far - Skin, fascia and rectus abdominus

Question 28

Following wiring of a dehisced abdomen for how long should the horse be confined to a stall?

Answer 28

60 days

Question 29

Incidence of herniation after midline celiotomy

Answer 29

8.1-16%

Question 30

When do incisional hernias usually become apparent

Answer 30

2-3 months post discharge from hospital

Question 31

How soon after identifying an incisional hernia should a repair be attempted and why

Answer 31

3-4 months to allow time for local inflammation/infection to resolve and for hernial ring to mature making it more apparent and capable of holding suture

Question 32

What are the 5 techniques of primary closure using mesh

Answer 32

1- Onlay 2- Inlay 3- Retrorectus sublay 4- Peritoneal sublay 5- Underlay

Question 33

Benefit of primary closure of an incisional hernia without the use of mesh

Answer 33

1- Decreased risk of SSI 2- Shorter sx time 3- Cheaper 4- Eliminates risk of adhesion btw mesh and viscera 5- Shorter hospitalisation 6- Shorter return to exercise

Question 34

Cons of primary closure of an incisional hernia without the use of mesh

Answer 34

Multiple small gaps

Question 35

Up to what length and width has primary closure with suture been reported for repair of an incisional hernia

Answer 35

28cm long or 18cm wide

Question 36

How far beyond the hernial ring is the subcutaneous tissue dissected in incisional hernia repair

Answer 36

4-5cm

Question 37

% rate of short term complications reported in incisional hernia repair when a mesh was not used in primary closure

Answer 37

11%

Question 38

% rate of long term complications reported in incisional hernia repair when a mesh was not used in primary closure

Answer 38

4%

Question 39

when performing onlay mesh placement how far cranial and caudal to the hernia ring should the incision be extended

Answer 39

6-8cm

Question 40

How much of the external sheath of the rectus abdominis m. is exposed in the onlay mesh placement

Answer 40

6cm

Question 41

Where is the mesh placed in a rectorectus sublay technique

Answer 41

Between rectus abdominis m. and its internal sheath

Question 42

Where is the mesh placed in a peritoneal sublay technique?

Answer 42

Between internal sheath of rectus abdominis and peritoneum

Question 43

What complications were reported in a retrospective study of 13 horses undergoing repair of an incisional hernia with preperitoneal sublay technique

Answer 43

1. All - Mild to moderate abd pain <24hrs post op 2. All - Seroma or hematoma formation 3. 8 - developed incisional drainage 4. 3 - Tear of internal abdominal oblique near mesh tissue interface

Question 44

Material of mesh advised for laparoscopic underlay mesh repair for incisional hernia

Answer 44

Poly tetra fluoro ethylene

Question 45

Why use a polytetrafluoroethylene mesh

Answer 45

Prevents adhesion formation between the mesh and the viscera

Question 46

In a report of 11 equids undergoing repair of a lateral abdominal wall hernia what was their recovery period?

Answer 46

2 weeks stall, 4 weeks small paddock, Back to work 42-56 days

Question 47

The prepubic tendon attaches where?

Answer 47

Cranial border of the pubis including iliopubic eminences

Question 48

What muscles does the republic tendon serve as the tendon of insertion for?

Answer 48

1. External sheath of rectus abdominis m. 2. Gracilis m. 3. Pectineus m.

Question 49

Which horses most commonly experience prepubic tendon rupture

Answer 49

Aged draft horses during late pregnancy

Question 50

Stance of mare with republic tendon rupture

Answer 50

Saw horse, marked lordosis, elevation of tail and tuber ischia.

Question 51

How to confirm diagnosis of republic tendon rupture

Answer 51

Discontinuity of of abdominal wall cranial to pubis on transcutaneous ultrasound

Question 52

Treatment for term or near term mares with republic tendon rupture

Answer 52

Induce parturition with 75IU Oxytocin in 1L saline over 1 hour

Question 53

Why are diaphragmatic hernias commonly false hernias

Answer 53

Often lack a hernial sac

Question 54

Where are acquired diaphragmatic hernias most often located?

Answer 54

Musculotendinous portion of the diaphragm

Question 55

Where are congenital diaphragmatic hernias most often located?

Answer 55

Left dorsal tendons portion of the diaphragm

Question 56

Causes of congenital diaphragmatic hernia?

Answer 56

1 - Trauma in utero 2 - Trauma in parturition 3 - Failure of the embryonic components of the diaphragm to fuse

Question 57

Where is a morgagni hernia located

Answer 57

Retrosternal diaphragmatic hernia Right ventral aspect of diaphragmatic musculature

Question 58

How/why do (Morgagni) retrosternal diaphragmatic hernia occur

Answer 58

Failed fusion of the septum transversum and the pleuroperitoneal folds

Question 59

What is the hernial sac of the retrosternal hernia made up of?

Answer 59

Peritoneum and pleura

Question 60

At what age do retrosternal hernia become clinically apparent

Answer 60

1 year

Question 61

What % of horses with diaphragmatic hernia have auscultatable borborygmi in the thorax?

Answer 61

80%

Question 62

When repairing a diaphragmatic hernia how is the celiotomy incision extended to best visualise the lesion

Answer 62

Finochetto rib retractor

Question 63

When performing a standing thoracoscopy to repair a diaphragmatic hernia, through which intercostal space was the scope introduced

Answer 63

10th