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Y4: Breast and abdominal wall surgery > Hernia surgery > Flashcards

Hernia surgery Flashcards

1
Q

What is an incisional hernia?

A
  • Protrusion of a viscus through a previous incision in the compartment wall
  • Common complication of abdominal surgery
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2
Q

Pathophysiology of an incisional hernia?

A
  • 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
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3
Q

Complications of an incisional hernia?

A
  • Incarceration
    • Hernia is irreducible
  • Strangulation
    • Blood supply to hernia is compromised
  • Bowel obstruction
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4
Q

Name some risk factors for an incisional hernia following abdominal surgery?

A
  • Obese
  • Older age
  • Midline incision
  • Emergency surgery
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5
Q

Clinical features of an incisional hernia?

A
  • Non-pulsatile, reducible, soft and non-tender swelling
    • At or near a previous surgical wound
  • If incarcerated: painful, tender erythematois
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6
Q

Name another differential for an incisonal hernia?

A
  • Very narrow differentials due to the specificites
    • Lipoma
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7
Q

Investigations into an incisional hernia?

A
  • Clinical diagnosis
  • Imaging to investigate if diagnosis is unclear
    • Ultrasound - which cough reflex/valsalva
    • CT scan
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8
Q

Describe the management of an incisional hernia?

A
  • 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
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9
Q

What are the common complications of hernia repair surgery?

A
  • Pain
  • Bowel injury
  • Seroma formation
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10
Q

What is an inguinal hernia?

A
  • When abdominal cavity contents enter the inguinal canal
  • Most common type of hernia
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11
Q

What are the subtypes of inguinal hernias?

A
  • Direct inguinal hernia (20%)
  • Indirect inguinal hernia (80%)
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12
Q

Describe Direct inguinal hernias?

A
  • Bowel enters canal directly through the posterior wall,
    • Hesselbach’s triangle
  • More common in elderly
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13
Q

Describe Indirect inguinal hernias?

A
  • Bowel enters the inguinal triangle via the deep inguinal ring
  • Incomplete closure of the processus vaginalis
    • Outpouching of peritoneum allowing for embryonic testicular descent
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14
Q

How can inguinal hernias be differentiated?

A
  • Only at time of surgery
    • Direct: medial to inferior epigastric vessels
    • Indirect: lateral to inferior epigastric vessels
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15
Q

What are the main risk factors for developing an inguinal hernia?

A
  • Male
  • Increasing age
  • Raised intra-abdominal pressure
    • Chronic cough, heavy lifting, chronic constipation
  • Obesity
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16
Q

What are the clinical features of an inguinal hernia?

A
  • Lump in the groin
    • Superomedial to the pubic tubercle
  • Discomfort when standing or during acitivity
  • Cough impulse
  • Reducible on lying down
17
Q

Differentials for an inguinal hernia?

A
  • Femoral hernia
  • Saphena varix
  • Inguinal lymphadenoapthy
  • Groin abscess
18
Q

Describe the management of inguinal hernias?

A
19
Q

What are the serious complications of a hernia that require urgent intervention?

A
  • Irreducible/incarcerated
  • Obstruction
  • Strangulation
    • Surgical emergency due to bowel infarction risk
20
Q

What are the main complications of hernia repair surgery?

A
  • Pain, bruising, haematoma
  • Recurrence (1% within 5yrs)
  • Chronic pain
  • Damage to vas deferens or testicular vessels
21
Q

Describe femoral herniae?

A
  • 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
22
Q

Which gender are femoral herniae more common in and why?

A
  • More common in women
  • Due to wider anatomy of pelvis
23
Q

Describe the anatomy of the femoral canal?

A
24
Q

How can you differentiate between a femoral and inguinal hernia?

A
  • Femoral
    • Found infero-lateral to the pubic tubercle (medial to femoral pulse)
  • Inguinal
    • Supero-medial to the pubic tubercle
25
Q

Name some differentials for a femoral hernia?

A
  • Inguinal hernia
  • Lipoma
  • Enalrged lymph node
26
Q

How do you differentiate a hernia from saphena varix?

A
  • Saphena varix will disppear when lying flat
  • Palpable thrill when coughing
  • Presence of varicose veins elsewhere
27
Q

Describe the management of a femoral hernia?

A
  • Surgery within 2-4 weeks due to high strangulation risk
  • Low approach or high approach
    • Incision above or below the inguinal ligament
  • Hernia is reduced, femoral ring is narrowed with sutures or a mesh plug
28
Q

How are femoral hernias diagnosed?

A
  1. Clinical decision
  2. US (goldstandard)
  3. Surgical exploration
29
Q

Deescribe an Epigastric hernia?

A

Occur in upper midline through fibres of linea alba

30
Q

Describe a paraumbilical hernia?

A

Occur through the linea alba around the umbilical region

31
Q

Describe a Spigellian hernia?

A

Occur at semilunar line around the level of the arcuate line

32
Q

Describe an Obturator hernia?

A

Through obturator foramen into the obturator canal

33
Q

Describe Richter’s herniae?

A

Partial herniation of bowel involving anti-mesenteric border

34
Q

Which hernia involves herniation of a Meckel’s diverticulum?

A

Littre’s

Y4: Breast and abdominal wall surgery (5 decks)

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