Gen Surg: inguinal and femoral hernias

Question 1

What is a direct inguinal hernia?

Answer 1

Bowel enters the inguinal canal through a weakness in Hesselback’s triangle (posterior wall).

Question 2

What is an indirect inguinal hernia?

Answer 2

Bowel enters the inguinal canal via the deep inguinal ring.

Question 3

Why may a direct inguinal hernia come about?

Answer 3

Secondary to an increased abdominal pressure or abdominal wall laxity.

Question 4

Why may an indirect inguinal hernia come about?

Answer 4

From incomplete closure of processus vaginalis.

Question 5

Name a RF for an inguinal hernia?

Answer 5

Male, raised intra abdominal pressure, obesity, increased age

Question 6

How does an inguinal hernia present?

Answer 6

Lump in groin. Bowel obstruction. Mild-moderate discomfort which worsens with activity or standing.

Question 7

What investigations would you carry out for suspected inguinal hernia?

Answer 7

Usually diagnosed by clinical features. USS recommended as first line imagining. CT imaging required if there are features of obstruction or strangulation.

Question 8

How are inguinal hernias managed?

Answer 8

Surgical intervention - open or laparoscopic repair. Open repairs are preferred for primary inguinal hernias. Lapro is preferred in bilateral or recurrent hernias.

Question 9

What are complications of inguinal hernia?

Answer 9

Incarceration, strangulation, obstruction

Question 10

What are post op complications of inguinal hernia repair?

Answer 10

• bruising and haematoma ( scrotal or inguinal wound)
• recurrence,
• chronic pain,
• damage to vas deferent or testicular vessels.
• urinary retention (usually resolves within 24 hrs
• wound infection

Question 11

What is the pathophysiology of femoral hernias?

Answer 11

Abdominal viscera or the abdominal omentum pass through the femoral ring, and into the potential space - the femoral canal

Question 12

What are risk factors of having a femoral hernia?

Answer 12

• Female,
• pregnancy,
• raised intra abdominal pressure from heavy lifting etc,
• increasing age.

Question 13

How do femoral hernias present?

Answer 13

Small lump in groin but otherwise asymptomatic usually. Can present as an emergency. Found medial to the femoral pulse and inferno-lateral to the pubic tubercle.

Question 14

What investigations would you do for a suspected femoral hernia?

Answer 14

USS. CT abdo-pelvis. Lump to be explored surgically.

Question 15

How is a femoral hernia managed surgically?

Answer 15

Managed within 2 weeks of presentation, due to high risk of strangulation. Managed by surgical reduction and narrowing the femoral ring.

Question 16

What are complications of femoral hernia?

Answer 16

Risk of strangulation.
Risk of obstruction.
Increased morbidity and 20 times higher mortality.
Risk of bowel resection, wound infection and cardioresp complications - if acute femoral hernia.