Hernia Flashcards
General hernia positions
Strangulated definition
Blood supply compromised due to pressure at neck of hernia
Maydl’s Hernia
Herniating double loop of bowel
Strangulated portion may reside as a single loop inside the abdomen
Littre’s hernia
Hernial sac containing strangulated Meckel’s diverticulum (small pouch in small intestine near umbilicus)
Amyand’s hernia
Inguinal hernia containing strangulated Appendix
Richter’s hernia
Only part of circumference of bowel is within sac
Most commonly seen with femoral hernias.
Can strangulate without obstructing.
Pantaloon
Simultaneous direct (being fat/old) and indirect(congenital abnormality) hernia
Herniotomy
Excision of hernial sac
Herniorrhaphy
Suture repair of hernial defect
Hernioplasty
Mesh repair of hernial defect
Epidemiology of inguinal hernias
M>F 9:1 due to descent of testes
Commoner on the right
Indirect inguinal hernias anomaly
-Congenital patent processus vaginalis
Route of indirect inguinal hernia
- Emerge through deep ring
- Same 3 coverings as cord and descend into the scrotum
Direct inguinal hernias route
- Acquired (increased intra-abdominal pressure)
- Emerge through Hesselbach’s triangle
Which one is more common, direct or indirect inguinal hernia
indirect 80%
direct 20%
Which strangulates direct or indirect inguinal hernia
indirect
Which inguinal hernia do young get
indirect
Questions to ask for inguinal hernias
- Reducible?
- Ever episodes of obstruction / strangulation?
- Predisposing factors: cough, straining, lifting?
- Occupation and social circumstances?
- Children worse when crying?
Non surgical treatment of inguinal hernias
- Reduce Risk Factors: cough, constipation
- Lose weight
- Truss (hernia pants)
Surgical rx of inguinal hernia
Tension-free mesh
Femoral hernia definition
Protrusion of viscus through femoral canal
Clinical features of femoral hernias
Painless groin lump:
- neck inferior/lateral to pubic tubercle
- cough impulse
- often irreducible
Often present with strangulation/obstruction
Treatment of femoral hernias
50% risk of strangulation within 1 month so urgent surgery needed
Elective = Lockwood approach
Emergency = McEvedy approach
Incisional Hernias definition
Hernia through surgical incision
Risk factors for incisional hernias (pre/intra/post operation)
Pre op:- Age- Obesity
Intra-op:- Surgical skill (inappropriate sutures)- Incision type- Placing drains through wounds
Post-op:- Increased intra abdo pressure- Infection - Haematoma
Treatment of incisional hernias
Conservative- Manage risk factors: e.g. constipation, cough- Weight loss- Elasticated corset or truss
Surgical- Nylon mesh repair: open or lap
Risk factors of umbilical hernias
- Afro-Caribbean
- Trisomy 21 (Down’s)
- Congenital hypothyroidism
Management of umbilical hernias
- Usually resolves by 2-3yrs
- Mesh repair if no closure.
- Can recur in adults: pregnancy or gross ascites
Paraumbilical hernia features
- Acquired: middle aged obese men
- Defect through linea alba just above or below umbilicus
- Small defect –> strangulation (often omentum)
Parumbilical hernia treatment
Mayo technique (sutures) or Mesh repair
Epigastric hernia features
- Young, M>F
- Pea-sized swelling caused by defect in lineaalba above the umbilicus.
- Usually contains omentum: can strangulate
Treatment of epigastric hernias
Mesh repair
