Hernias

Question 1

Define a hernia

Answer 1

An abnormal protrusion of a viscus outwith its normal body cavity

Question 2

Predisposing factors to abdominal hernias

Answer 2

heavy lifting 
coughing 
constipation 
pregnancy 
obesity 
type 2 collagen deficiency 
prostatism (bilateral direct inguinal hernia)

Question 3

Hernias can be…

Answer 3

reducible or irreducible

Question 4

What is an incarcerated irreducible hernia?

Answer 4

useless but not affecting bowel within hernial sac

Question 5

A hernia described as strangulated, means what?

Answer 5

denotes compromise of the blood supply of the contents of the hernial sac
It’s development increases morbidity and mortality
low pressure venous system is occluded first, then the arterial supply becomes occluded and gengrene develops

Question 6

An obstructed irreducible hernia gives what?

Answer 6

Pain

Question 7

Causes of an incisional hernia

Answer 7

created as a result of an incision
age, obesity, genral debility, post-op wound infection or haemotoma and increased intra-abdominal pressure can lead to an incisional hernia

Question 8

If a pt is predisposed to an incisional hernia, what should be used?

Answer 8

tension sutures and “mass closure” of the linea alba

Question 9

How do umbilical and paraumbilical hernias differ?

Answer 9

umbilical - kids outty belly button, usually resolves by 3years - if not then surgery
paraumbilical - adult and obese

Question 10

What does an epigastric hernia arise from?

Answer 10

congenital weakness in the linea alba

Question 11

What does an epigastric hernia usually contain?

Answer 11

extraperitoneal fat

Question 12

Are epigastric hernias more common in males or females? What is the ratio?

Answer 12

Males: females 3:1

Question 13

How are epigastric hernias repaired?

Answer 13

sutures or mesh

Question 14

What predisposes a child to a paediatric inguinal hernia?

Answer 14

patent processus vaginalis (PPV) [normally closes off when testicles drop]
more common in pre-term and LBW babies

Question 15

Are paediatric inguinal hernias more common in males or females? ratio?

Answer 15

Males, 9:1

Question 16

Does having a paediatric inguinal hernia increase the chance of anything?

Answer 16

20% chance of developing a conralateral hernia

Question 17

Can paediatric inguinal hernia become strangulated?

Answer 17

Yes, high risk of strangulation and must be operated on urgently (<24hours) if this develops

Question 18

What is a femoral hernia?

Answer 18

Defect though the femoral canal

Question 19

Where is a femoral hernia?

Answer 19

Below and lateral to pubic tubercle

usually flattens the groin crease

Question 20

Are femoral hernias more common in males or females?

Answer 20

females, 10:1

Question 21

Where are inguinal hernias?

Answer 21

Above and medial to the pubic tubercle
increase groin crease
Could be Inguino-scrotal – goes into scrotum - indirect

Question 22

How can you determine if an inguinal hernia is direct or indirect?

Answer 22

pressure over deep inguinal ring and ask patient to cough

if pops out then direct inguinal hernia

Question 23

What is a direct inguinal hernia?

Answer 23

• posterior buldge through the transversalis fascia
• it is medial to inferior epigastric vessels
• often bilateral
• more common in older men

Question 24

Who is most likely to suffer a femoral hernia? (obstructing irreducible)

Answer 24

Thin elderly female with small bowel obstruction

Question 25

Scrotal swellings - can you get above the swelling?

Answer 25

yes - primary swelling from scrotum

no - hernia

Question 26

Scrotal swellings - can you feel the testes separate?

Answer 26

Yes - epididimal cyst

No - hydrocele

Question 27

What is an indirect inguinal hernia?

Answer 27

• Lateral to inferior epigastric vessels and with the cord
• May reach to the scrotum (inguino-scrotal)
• Congenital hernias are indirect (ppv)
• M/F ratio 10/1 (esp young men)

Question 28

Inguinal hernias should be operated when..?

Answer 28

• hernia at risk of complications
• hernia with previous symptoms of obstruction
• hernia interfering with lifestyle

Question 29

Complications of an inguinal hernia

Answer 29

• Haematoma (wound or scrotum)
• Acute urinary retention
• Wound infection (~5%)
• Chronic neurogenic pain (15-30%)
• Hernia Recurrence (ideal <5%)
• Testicular pain and atrophy

Question 30

Types of operations for inguinal hernias

Answer 30

• Suture
• Open Mesh
• Laparoscopic: Intraperitoneal (TAPS)
  Extraperitoneal (TEPS)

Question 31

What shouldn’t a patient post-op inguinal hernia do?

Answer 31

drive for about a week
heavy lift for one month (1 hand lift only)
to let mesh get fibrosed in

Question 32

When consenting a patient for inguinal hernia repair, what should they be told about?

Answer 32

• Wound infection/haematoma (<5%

- 15% chance of neurogenic pain post-op