Hernias

Question 1

Hernia

Answer 1

Protrusion of a viscus or part of a viscus through the walls of its containing cavity into an abnormal position

Question 2

Reducible

Answer 2

Sac can return to the abdominal cavity either spontaneously or with manipulation

Question 3

Strangulated

Answer 3

Blood supply of contents is compromised due to pressure at the neck of the hernia

Question 4

Causes of inguinal hernia

Answer 4

Congenital: patent processus vaginalis

Acquired:  ↑IAP
• Chronic cough: COPD, asthma
• Prostatism
• Constipation
• Heavy lifting
• Previous incision/repair
• Ascites / obesity

Question 5

Indirect inguinal hernia

Answer 5

• Emerge through deep ring lateral to the inferior epigastric vessels
• Exits superficial ring into scrotum
• Can strangulate

Question 6

Direct inguinal hernia

Answer 6

• Emerge through Hesselbach’s triangle
• Medial to inferior epigastric vessels
• Can acquire internal and external spermatic fascia
• Rarely descend into scrotum
• Rarely strangulate

Question 7

Surgery to treat hernias

Answer 7

Tension-free mesh (Lichtenstein repair) better than suture repair

• Open approach can be done under LA or GA
• Lap approach allows bilateral repair and preferred for recurrent hernias.
• Primary unilateral repair - open

Question 8

Complications of hernia surgery

Answer 8

• Early

• Haematoma / seroma formation
• Intra-abdominal injury (lap)
• Infection
• Urinary retention

• Late

• Recurrence (
• Ischaemic orchitis
• Chronic groin pain/ paraesthesia

Question 9

Femoral hernia

Answer 9

Protrusion of viscus through the femoral canal, below pubic tubercle

• more common in females
• Commonly present with obstruction or strangulation

Question 10

How does obstruction or strangulation present?

Answer 10

• Tender, red and hot

* Abdo pain, distension, vomiting, constipation

Question 11

Femoral hernia surgery

Answer 11

50% risk of strangulation therefore surgically treated

Herniotomy:

• Lockwood Approach
• McEvedy Approach