Hernia Flashcards
Define hernia
Protrusion of viscus or part of viscus through wall containing it
Parts of hernia
Sac
Contents
Defect
Blood supply
What are the hallmarks of uncomplicated hernia
Reducability and cough impulse
Obstructed/invarcerated hernia are
Irreducible
No cough impulse
Blood supply is intact
Strangulated hernia
Obstructed and compromised blood supply
Dictum about hernia
All obstructed hernia are considered strangulated unless proved otherwise
What is taxis
Process of reduction of hernia
Forceful taxis should be avoided in
Obstructed and strangulated hernia
Based on content of hernia
Omentocele-omemtum
Enterocele-bowel
Omentocele vs enterocele diffrentiation
Omentocele
Palpatipon–doughy consistensy
Easy to reduce first part
Difficult to reduce second part
Enterocele
Visible peristalsis
Difficult to reduce first part
Easy to reduce second part
Percussion–tympanic note
Auscultation-bowel sound
Depending on the content of hernia
Meckels diverticulum-littres hernia
Appendix-amayand hernia
Surgical management of hernia
Herniotomy
Hernioraphy
Hernioplasty
Herniotomy procedure
Identify the sac and push the contents inside
If the sac is opened it should be closed and reduced
Don’t do anything to defect
High recurrence rate
Herniotomy is the treatment of choice for
Congenital inguinal hernias
Congenital hydrocele
Herniorraphy
Same 2 steps as in herniotomy
Step 3–suture two edges together
Most common cause of failure of herniorraphy
Increased tension in repair
Examples of herniorraphy technique
BASSINI
SHOULDICE
MAYO
Herniorraphy is indicatee in
Infected and strangulated hernia
Hernioplasty
Step 3-mesh over the defect
Least recurrent hernia surgery
Hernioplasty
Tension free
LICHTENSTEINS TENSION FREE MESH HERNIOPLASTY
Meshes in hernioplasty
Synthetic
Avoided in infection and strangulation
Bilogical
Can be used in infection
Biological mesh examples
Acellular humar dermis (alloderm)
Acellular porcine dermis
Synthetic mesh ex
Prolene mesh
Polyester mesh
VIPRO -Vicryl+prolene
Poly tetra fluoro ethylene (PTF)
Syntheic meshes types
Solid mesh
Need to fix them with sutures and staplers
Net mesh
Fibrous tissue can grow through pores they can remain in place without suture
Mesh material
Prolene mesh
Strong
Hydrophobic
Polyester
Hydrophilic(risk infection)
But due to rapid ingrowth into mesh infection prevented
Poly tetra fluro ethylene mesh (solid mesh)
Does not become adherent to tissue
Can be placed intraperitoneal mesh
Fenestrated PTFE mesh allows peritomeum to grow through
Mesh shrinkage
Upto 50% shrinkage can occur
Pain
A largeesh shoud be used atleast 5cm overlap on all sides
Mesh depending onweight
Low –<40gm/m2
Hig weight –>80 gm/m2
What kinda mesh to choose
Low weight
Thin fibres
Large pores
Plug mesh
Problem
Increased collegen deposition and meshoma
