General Surgery/GIT / Inguinal Hernia

Question 1

What is the lifetime risk of developing a groin hernia (inguinal or femoral)?

Answer 1

25% in males and 5% in females

Question 2

How do indirect inguinal hernias develop?

Answer 2

• The hernia comes from the internal ring where the spermatic cord (in males) and the round ligament (in females) exits the abdomen.
• The failure of the internal ring to close (following migration of the testicle into the inguinal canal) combined with the failure of obliteration of the processus vaginalis lead to the defect through which the hernia can develop.

Question 3

On which side do indirect hernias frequently develop?

Answer 3

The right, which is the side that descends last

Question 4

The origin of indirect inguinal hernias is lateral to the inferior epigastric artery. True or false?

Answer 4

True. Direct inguinal hernias are medial to the inferior epigastric artery.

Question 5

How do direct inguinal hernias develop?

Answer 5

• Direct inguinal hernias develop through Hesselbach triangle (formed by the inguinal ligament inferiorly, the inferior epigastric vessels laterally, and the rectus abdominis muscle medially).
• These hernias are the result of weakness (which can be congenital or acquired) in the floor of the inguinal canal.

Question 6

What are the clinical manifestations of inguinal hernias?

Answer 6

• Inguinal hernias cause heaviness or dull discomfort in the inguinal region that is increased with straining or lifting and relieved by lying down.
• The discomfort is often worse at the end of the day after prolonged standing.
• Patients can also be asymptomatic.

Question 7

List the steps in evaluating a patient with a suspected hernia.

Answer 7

1. Visually inspect the patient in the standing position.
2. Using the second or third finger, invaginate the scrotal skin and follow the spermatic cord upward to the triangular opening of the external inguinal canal.
3. If possible, follow the inguinal canal laterally.
4. With your finger in the external ring or within the canal, ask the patient to cough.
5. Note any mass as it touches your finger.

Question 8

What is an incarcerated hernia?

Answer 8

A hernia that cannot be manually reduced

Question 9

What happens when an incarcerated hernia becomes strangulated?

Answer 9

There is decreased blood flow to the contents of an incarcerated hernia leading to ischemia and necrosis.

Question 10

Why are inguinal hernia repairs performed?

Answer 10

• Inguinal hernia repairs are performed to reduce symptoms and prevent hernia strangulation.
• Watchful waiting is an acceptable option for asymptomatic, minimal hernias in patients who wish to avoid surgery.