Hernia sx Flashcards
Define a hernia.
Protrusion of contents through a defect in the wall of the cavity in which it normally lies
anatomical classifications of hernias.
- Paracostal
- Dorsal lateral
- Inguinal
- Cranial pubic ligament
- Femoral
- Umbilical
- Ventral
- Scrotal
True vs. false hernia.
a true hernia has a sac, peritoneal covering, congenital
a false hernia does NOT have a sac, traumatic
acquired vs congenital hernias.
Acquired:
degenerative (e.g. perineal)
traumatic
iatrogenic (e.g. sx)
Congenital:
defect already prsent at birth but herniation may not occur until later
reducible, incarcerated, and strangulated hernia contents?
reducible:
contents rdily manipulated into cavity
incarcerated:
contents fixed into abnormal location - usually due to adhesions
strangulated:
incarceration obstructs vascular supply - usually sx emergency
parts of a hernia.
Ring: anatomical limits
Sac: peritoneal covering
Contents
principles of herniorrhaphy?
ensure viability
return viable contents
obliterate redundant tissue in sac
secure, tension free closure of defect
pts own tissue when posible
Why don’t we freshen the edges of a hernia?
greater tendency for adhesions
How and when do you treat an umbilical hernia?
if small (<3mm) or large (>2.5cm) 1st tx conservatively, may close spontaneously in pt <6 mos
then repair during elective procedure
if finger size in sm to med dog do not wait to repair
If corrected during spay
Incision extended cranially over hernia (or can make elliptical incision over hernia)
Dissect sac and invert into abdomen (closed)
OR ligate sac at neck and transect (open)
Perform routine closure (Do not freshen)
Incarcerated hernias
Enlarge ring and dissect sac free then
examine contents
suture materials
Differentiate direct/ indirect and congenital/acquired inguinal hernias.
Indirect: - more common
passes through vaginal process
called scrotal hernia in male
Direct: - less common
passes through inguinal musculature
Congenital: - rare
more common in males < 2yo
Acquired: - relatively common
middle aged intact females
estrogen/estrus
overweight
How and when to repair inguinal hernias?
Do not delay surgery!
traditional repair often in males
Incision over lateral aspect of swelling
Extend ring if cannot reduce contents
Close ring
Avoid pudendal artery and genitofemoral n.
ventral midline approach common in females
perform 1 layer closure over ring
What is a scrotal hernia and how and when do you repair it?
d/t weakness of vaginal orifice
Incision over ring
Reduce contents and close ring
Castrate
How and when should you repair traumatic abdominal hernias (Acute vs. chronic)?
Stabilize pt first!
Acute ab hernia repair:
Ventral midline
Can explore abdomen
Repair organ injury
Difficult to reconstruct
2/0 monofilament
Tension relieving pattern
Cruciate
Horizontal mattress
Vertical mattress
Chronic abd hernia repair:
Approach over hernia
Less likely concurrent injuries
Better anatomic closure
Can perform both approaches
What is prepubic tendon rupture and how do you repair?
often associated w/ pelvic fractures
drill holes in pubis
synthetic mesh
Predisposing factors to incisional hernias and when do they occur.
acquired hernia from disruption of surgicallyy closed cavity
occurs <7 days post op (most 3-5 days)
