Hernia surgery Flashcards
What is an incisional hernia?
- Protrusion of a viscus through a previous incision in the compartment wall
- Common complication of abdominal surgery
Pathophysiology of an incisional hernia?
- When the layers of the anterior abdominbal wall are disrupted, they can be structurally weakened
- With increased intra-abdominal pressure or risk factors the abdomen contents can herniate through the weakness
Complications of an incisional hernia?
- Incarceration
- Hernia is irreducible
- Strangulation
- Blood supply to hernia is compromised
- Bowel obstruction
Name some risk factors for an incisional hernia following abdominal surgery?
- Obese
- Older age
- Midline incision
- Emergency surgery
Clinical features of an incisional hernia?
- Non-pulsatile, reducible, soft and non-tender swelling
- At or near a previous surgical wound
- If incarcerated: painful, tender erythematois
Name another differential for an incisonal hernia?
- Very narrow differentials due to the specificites
- Lipoma
Investigations into an incisional hernia?
- Clinical diagnosis
- Imaging to investigate if diagnosis is unclear
- Ultrasound - which cough reflex/valsalva
- CT scan
Describe the management of an incisional hernia?
- Usually conservative as they are asymptomatic
- Decision for surgery is based on patient fitness, clinical features, age, hernia size and co-morbidities
- Types of surgery:
- Suture repair
- Laparoscopic mesh repair
- Open mesh repair
What are the common complications of hernia repair surgery?
- Pain
- Bowel injury
- Seroma formation
What is an inguinal hernia?
- When abdominal cavity contents enter the inguinal canal
- Most common type of hernia
What are the subtypes of inguinal hernias?
- Direct inguinal hernia (20%)
- Indirect inguinal hernia (80%)
Describe Direct inguinal hernias?
- Bowel enters canal directly through the posterior wall,
- Hesselbach’s triangle
- More common in elderly
Describe Indirect inguinal hernias?
- Bowel enters the inguinal triangle via the deep inguinal ring
- Incomplete closure of the processus vaginalis
- Outpouching of peritoneum allowing for embryonic testicular descent
How can inguinal hernias be differentiated?
- Only at time of surgery
- Direct: medial to inferior epigastric vessels
- Indirect: lateral to inferior epigastric vessels
What are the main risk factors for developing an inguinal hernia?
- Male
- Increasing age
- Raised intra-abdominal pressure
- Chronic cough, heavy lifting, chronic constipation
- Obesity
What are the clinical features of an inguinal hernia?
- Lump in the groin
- Superomedial to the pubic tubercle
- Discomfort when standing or during acitivity
- Cough impulse
- Reducible on lying down
Differentials for an inguinal hernia?
- Femoral hernia
- Saphena varix
- Inguinal lymphadenoapthy
- Groin abscess
Describe the management of inguinal hernias?
What are the serious complications of a hernia that require urgent intervention?
- Irreducible/incarcerated
- Obstruction
- Strangulation
- Surgical emergency due to bowel infarction risk
What are the main complications of hernia repair surgery?
- Pain, bruising, haematoma
- Recurrence (1% within 5yrs)
- Chronic pain
- Damage to vas deferens or testicular vessels
Describe femoral herniae?
- Abdominal viscera or omentum through the femoral ring into the femoral canal
- Uncommon but high risk of strangulation and incarceration
- Tightness of the femoral rings
Which gender are femoral herniae more common in and why?
- More common in women
- Due to wider anatomy of pelvis
Describe the anatomy of the femoral canal?
How can you differentiate between a femoral and inguinal hernia?
- Femoral
- Found infero-lateral to the pubic tubercle (medial to femoral pulse)
- Inguinal
- Supero-medial to the pubic tubercle
