Hernias

Question 1

What is a hernia?

Answer 1

abnormal protrusion of an organ or part of an organ through its containing body wall

Question 2

What is a Richter’s hernia?

Answer 2

where partial thickness of the bowel is trapped within the hernia
leads to partial bowel obstruction

Question 3

What is a sliding hernia?

Answer 3

peritoneal covered structure such as colon or bladder slides down extra-peritoneally with the peritoneum adjacent to it and forms the wall of the hernia sac

Question 4

What is a pantaloon hernia?

Answer 4

direct and indirect inguinal hernia occurring simultaneously

Question 5

Direct vs Indirect inguinal hernia?

Answer 5

Indirect herniate through the inguinal canal (leaves abdomen through deep inguinal ring and exits through superficial inguinal ring)
Direct herniate directly through the Hesslebach’s triangle of transversalis fascia

Question 6

Location of direct vs indirect inguinal hernia?

Answer 6

Direct occurs medially to the inferior epigastric vessels
Indirect occurs laterally to the inferior epigastric vessels

Question 7

Where does the inguinal ligament run?

Answer 7

from the ASIS to the pubic tubercle

Question 8

Borders of Hesslebach’s triangle?

Answer 8

Recuts sheath
Inferior epigastric artery
Poupart’s ligament (Inguinal ligament)

RIP

Question 9

Contents of the inguinal canal?

Answer 9

3 vessels (testicular, vas deferens, cremasteric)
3 fasciae (external spermatic, internal spermatic, cremasteric)
3 others (spermatic cord, vas deferens, lymphatics)
4 nerves (cremaster, sympathetic, ilioinguinal, genitofemoral)

Question 10

Examination of inguinal hernia?

Answer 10

examine lying and standing
cough impulse
direct/indirect -> reduce and apply pressure over deep inguinal ring

Question 11

Mx of inguinal hernias?

Answer 11

strangulated/obstructed -> emergency repair

conservative -> elderly, significant co-morbidity, mild symptoms

surgical -> repair because of symptoms, not to prevent complications
tension-free or tension repair (tension-free preferred)
laparoscopic herniorrhaphy (if recurrent or bilateral)

Question 12

Complications of inguinal hernia repair?

Answer 12

scrotal haematoma
wound infection
urinary retention
chronic pain/paraesthesia in scrotum or labia majora (ilioinguinal nerve damage)
testicular atrophy (testicular artery)
recurrence

Question 13

Location of femoral hernia?

Answer 13

lateral and inferior to the pubic tubercle

Question 14

Complications of hernias?

Answer 14

incarceration
strangulation
obstruction

Question 15

What is a Maydl’s hernia?

Answer 15

two loops of bowel contained in the same hernia

Question 16

Boundaries of the femoral canal?

Answer 16

FLIP

Femoral Vein
Lacunar ligament
Inguinal ligament
Pectineal ligament

Question 17

Boundaries of femoral triangle?

Answer 17

SAIL

Sartorius
Adductor longus
Inguinal Ligament

Question 18

Contents of femoral triangle?

Answer 18

Canal
Vein
Artery
Nerve

Question 19

Contents of femoral canal?

Answer 19

lymphatics

Question 20

Mx of femoral hernia?

Answer 20

all require surgical repair due to high risk of complications

Question 21

Umbilical vs Para-umbilical hernia?

Answer 21

umbilical always congenital
para-umbilical always acquired

Question 22

RFs for peri-umbilical hernia?

Answer 22

obesity
pregnancy

Question 23

Umbilical vs Inguinal hernia in infants?

Answer 23

inguinal need urgent repair
umbilical do not (most self-resolve, if still present by 3 repair is needed)

Question 24

RFs for incisional hernia?

Answer 24

post-op wound infection
abdominal obesity
poor muscle quality (smoking, anaemia)
multiple operations through same incision
poor choice of incision
inadequate closure technique

Question 25

What is a Spigelian hernia?

Answer 25

defect between the lateral border of rectus abdominis and linea semilunaris
hard to diagnose clinically, US may be needed

Question 26

What is diastasis recti?

Answer 26

not a hernia!!! (no actual protrusion)
widening of the linea alba, the connective tissue that separates the rectus abdominis muscles

congenital or acquired (pregnancy or obesity)

Question 27

What is a Littre’s hernia?

Answer 27

herniation of Meckel’s diverticulum