Hernias Flashcards
Definition of a hernia
Protrusion of a viscus, or part of a viscus, through the walls of its containing cavity into an abnormal position
Definition of an incisional hernia
Protrusion through a previously acquired defect
Borders of Hesselbach’s triangle
Inferior epigastric artery, linea semilunaris (lateral border of the rectus muscle) and inguinal ligament
Floor of the inguinal canal
Inguinal ligament
Roof of the inguinal canal
Transversus abdominus and internal oblique
Medially to inguinal canal
Pubic tubercle
Laterally to inguinal canal
Deep inguinal ring (opening in transversals fascia at midpoint of inguinal ligament)
Anterior wall of inguinal canal
External oblique
Posterior wall of inguinal canal
Transversalis fascia and conjoint tendon (lateral 1/3rd)
Definition inguinal hernia
Emerges above and medial to pubic tubercle through superficial inguinal ring
Definition direct inguinal hernia
Enters inguinal canal directly through weakness or defect in posterior wall
Definition indirect inguinal hernia
Enters inguinal canal with spermatic cord structures through deep inguinal ring
Where does a femoral hernia arise?
Femoral ring
Characteristics of femoral hernia?
Not reducible No cough impulse Often contains only omentum More common on R Inferior and lateral to pubic tubercle
Differentials for a femoral hernia?
Inguinal hernia Femoral artery aneurysm, false femoral aneurysm Saphena varix Lymphadenopathy Psoas bursa Psoas abscess Lipoma Sarcoma Ectopic testis
Complications of open hernia repair?
Intraoperative:
Damage ileoinguinal nerve
Damage to cord structures e.g. vas def, testicular artery
Orchidectomy (To close posterior wall)
Early:
Urinary retention (pain)
Haematoma
Infection: mesh or wound
Late:
Recurrence
Cord damage –> testicular atrophy
Advantages of mesh repair?
Low recurrence rate
Tension free repair
Reduced analgesic requirement
Disadvantages of mesh repair?
Risk of infection- prophylactic abx
Who are inguinal hernias most common in?
Young-80%
What is the defect in inguinal hernias?
Congenital patent processus vaginalis
Who are direct hernias more common in?
Elderly
If a hernia descends into the scrotum what type is it most likely to be?
Indirect
Which paper determined that 56% of direct hernias were incorrectly classified as indirect on clinical examination?
Cameron BJS 1994
What surgery is recommended for inguinal hernia repair?
Lichtenstein tension free mesh repair
