Hernia Surgery Flashcards
Hernia
Protrusion of contents through a defect in the wall of the cavity in which it normally lies
What type hernia has no sac?
Traumatic Hernia
False Hernia
What Hernia has a sac?
True Hernia
Congenital Hernia
Congenital Hernia
Defect already present at birth but herniation may not occur until later
What are the types of Acquired Hernias?
Degenerative
Traumatic
Iatrogenic (surgery)
What are the locations of Abdominal Hernias?
Paracostal Dorsal lateral Inguinal Cranial pubic ligament Femoral Umbilical Ventral Scrotal
Reducible
Contents readily manipulated into cavity
Incarcerated
contents fixed into abnormal location
usually due to adhesions
Strangulated
incarceration obstructs vascular supply
usually surgical emergency
What are the principles of Herniorrhaphy?
Ensure viability Return viable contents Obliterate redundant tissue in the sac Secure closure of defect Use patients own tissue when possible
What is the most common abdominal hernia?
Umbilical Hernia
What are the congenital defects associated with Umbilical Hernia?
Cleft palate Cryptorchidism Cranial abdominal hernia Incomplete sternal fusion Fucosidosis
What are the clinical signs of an Umbilical Hernia?
Soft round mass at umbilical scar
Often reducible
viscera is entrapped and becomes hard and painful
What is the treatment for Umbilical Hernia?
Conservative treatment for small or large hernias - Repair during elective surgery
Direct Inguinal Hernia
Hernia passes through vaginal process
Direct Inguinal Hernia
Hernia passes through inguinal musculature
What is the most common form of Inguinal Hernias?
Indirect form
Which Inguinal Hernia is less likely to become incarcerated?
Direct Inguinal Hernia
Congenital Inguinal Hernia
More common in males less than 2 years old due to a delayed inguinal ring narrowing from late testicular descent
Acquired Inguinal Hernia
Common in middle aged overweight intact females due to a shorter or longer inguinal canal and associated with estrogen/estrus
What are the clinical signs of Inguinal Hernia?
Painless unilateral or bilateral mass in inguinal area
Unilateral more on the left
Describe Traditional Inguinal Hernia Repair
- Incision over lateral aspect of swelling
- Extend ring if cannot reduce contents
- Close ring
What is the cause of Scrotal Hernia?
Weakness of vaginal orifice
What causes Traumatic Abdominal Hernias?
Hit By Car
Clinical signs of Traumatic Abdominal Hernia
Bulging mass
Asymmetric abdomen
Reducible contents
Palpable ring
What patterns should you use for Acute Abdominal Hernia Repair?
Cruciate
Horizontal mattress
Vertical Mattress
Describe Prepubic Tendon Rupture Repair
Place the patient with Truncal flexion with rear legs forward
Drill holes in the pubis
Place Synthetic mesh
What suture should you use for Prepubic Tendon Rupture Repair?
Monofilament non-absorbable suture
What are predisposing factors for Incisional Hernias?
Intra-abdominal pressure: Obesity, Effusions, or pregnancy Entrapped fat Inappropriate suture Infection Steroids delay healing Post op care
When would you place an interrupted suture pattern in the closure of an Incisional Hernia?
pregnant
immunocompromised
How do you tell the difference between a seroma and a hernia?
Seroma will not reduce
Hernia will reduce
Perineal Hernia
Weakness and separation of the pelvic diaphragm
What are the types of perineal hernias?
Lateral
Dorsal
Caudal
Ventral
What is the most common perineal hernia?
Caudal
What are the predisposing factors for perineal hernia?
Hormonal influence from intact male
Relaxin secreted in patients with prostatic disease
Neurogenic atrophy from straining
Clinical signs of Perineal Hernia
Perineal swelling
Tenesmus
Constipation
Firm non-reducible painful mass
How do you diagnose Perineal Hernia?
Rectal Palpation
Radiographs
US
Medical Management for Perineal Hernia
Stool softeners
Periodic fecal evaluation
High fiber/high moisture diets
When does Perineal Hernia become an emergency?
Irreducible painful discolored swelling
Bladder retroflexion
Urethral obstruction
Azotemia
What are the surgical options for Perineal Hernia Repair?
Traditional Herniorrhaphy Internal obturator muscle transposition Superficial gluteal muscle transposition Semitendinosus muscle transposition Prosthetic implants
What do you preform if the surgery for Perineal Hernia Repair fails?
Colopexy
Cystopexy
Ductus deferopexy
What is the post op care for Perineal Hernia surgery?
4-6 weeks of stool softeners
Pain Management
What are the complications associated with Perineal Hernia Repair?
Infection/Abscess Fecal Incontinence Sciatic injury Urinary dysfunction Tenesmus
What effects the prognosis for Perineal Hernia Repair?
Surgeons experience Previous repairs Suture type Poor local tissue strength Amount of tension Castration
What are the predisposing factors for Feline Perineal Hernia?
Megacolon
Perineal masses
Colitis
