Hernia

Question 1

What is a hernia and what is the most common site?

Answer 1

• Abnormal protrusion or organ or tissue through defect in surrounding walls
• Most common - abdominal wall hernia

Question 2

How can hernias be described?

Answer 2

• External
• Interparietal
• Internal
• Reducible
• Non-reducible (aka incarcerated)
• Strangulated

Question 3

What are some types of abdominal wall hernias?

Answer 3

• Richter’s hernia
• Littre’s hernia
• Pantaloon
• Sliding
• Amyand
• Maydl (W)

Question 4

Give some examples of locations where hernias can form.

Answer 4

• Groin
• Umbilicus
• Linea alba (epigastric)
• Surgical incisions
• Semi-lunar line
• Diaphragm
• Lumbar triangles
• Pelvis

Question 5

Compare and contrast direct and indirect inguinal hernias.

Answer 5

• INDIRECT - more common in younger people. DIRECT - more common in old age
• INDIRECT - can descend into scrotum. DIRECT - cannot
• INDIRECT - linked to lateral to inferior epigastric vessels. DIRECT - linked to medial to inferior
• INDIRECT - passes through inguinal canal. DIRECT - bulge from posterior wall of canal

Question 5

What are the 3 types of groin hernias?

Answer 5

INDIRECT INGUINAL
DIRECT INGUINAL
FEMORAL

Question 6

Describe femoral hernias.

Answer 6

• Inferior to inguinal ligament
• Greater incidence in women than men
• Cloquet’s node
• Usually on medial aspect of femoral sheath

Question 7

How can groin hernias be diagnosed?

Answer 7

• Groin swelling that resolves with supine position
• Precipitating factors: Increased intra-abdominal pressure, defects in collagen synthesis, smoking
• Examine erect and supine
• Does not transilluminate

Question 8

What are some differential diagnosis for groin hernia?

Answer 8

• Hydrocele
• Varicocele
• Torsion of testis
• Undescended testis
• Ectopic testis
• Testicular tumor
• Femoral artery aneurysm
• Lymphadenopathy

Question 9

How can groin hernias be treated?

Answer 9

• Surgical repair with or without mesh
• Approaches can be open, laparoscopic, robotic (TEP and TAPP)

Question 10

What are some complications of groin hernias?

Answer 10

• Recurrence
• Neuralgia - Ilioinguinal, iliohypogastric, genitofemoral, lateral cutaneous
• Injury to vas deferens
• Wound infection
• Bleeding

Question 11

Describe umbilical hernias.

Answer 11

• Greater incidence in women than men
• Risk factors are obesity and pregnancy
• May rupture with ascites
• Can be repaired e.g with mesh
• Common in infants
• Close spontaneously if <1.5 cm
• Repair if > 2 cm or if persists at age 3-4 years

Question 12

Define epigastric hernia.

Answer 12

• Incidence 1-5%
• Greater incidence in men than women
• Pre-peritoneal fat protrusion through decussating fibers at linea alba
• Between xiphoid and umbilicus
• Repair primarily

Question 13

Describe incisional hernia.

Answer 13

• Risk factors - wound infections, smoking, hypoxia/ischemia, tension, obesity and malnutrition
• Repaired both open or laparoscopically

Question 14

Describe parastomal hernia.

Answer 14

• Variant of incisional hernia
• Low rate if through rectus muscle
• Traditionally relocate stoma, repair defect
• Concern for mesh erosion
• Laparoscopic repair

Question 15

Describe spigelian hernia.

Answer 15

• Rare
• Hernia through subumbilical portion of semi-lunar line
• Difficult to diagnose - Clinical suspicion (location) and CT scan
• Repair primarily or usually with mesh

Question 16

Describe areas that lumbar hernia can affect.

Answer 16

• Grynfeltt’s triangle - 12th rib, internal oblique and sacrospinalis muscle - Covered by latissimus dorsi
• Petit’s triangle - Latissimus dorsi, external oblique and iliac crest - Covered by superficial fascia

Question 17

What are the types of pelvic hernia?

Answer 17

• Obturator hernia - Most commonly in women
• Sciatic hernia
• Perineal hernia