Hernias

Question 1

Spigelian hernia

Answer 1

Interparietal hernia occurring at the level of the arcuate line
Rare
May lie beneath internal oblique muscle. Usually between internal and external oblique
Equal sex distribution
Position is lateral to rectus abdominis
Both open and laparoscopic repair are possible, the former in cases of strangulation

Question 2

Lumbar hernia

Answer 2

The lumbar triangle (through which these may occur) is bounded by:
Crest of ilium (inferiorly)
External oblique (laterally)
Latissimus dorsi (medially)
Primary lumbar herniae are rare, most are incisional hernias following renal surgery
- Direct anatomical repair with or without mesh re-enforcement is the procedure of choice

Question 3

Obturator hernia

Answer 3

Herniation through the obturator canal
Commoner in females
Usually lies behind pectineus muscle
Elective diagnosis is unusual most will present acutely with obstruction
When presenting acutely most cases with require laparotomy or laparoscopy (and small bowel resection if indicated)

Question 4

Richters hernia

Answer 4

Condition in which part of the wall of the small bowel (usually the anti mesenteric border) is strangulated within a hernia (of any type)
They do not present with typical features of intestinal obstruction as lumenal patency is preserved
Where vomiting is prominent it usually occurs as a result of paralytic ileus from peritonitis (as these hernias may perforate)

Question 5

Incisional hernia

Answer 5

Occur through sites of surgical access into the abdominal cavity
Most common following surgical wound infection
To minimise following midline laparotomy Jenkins Rule should be followed and this necessitates a suture length 4x length of incision with bites taken at 1cm intervals, 1 cm from the wound edge
Repair may be performed either at open surgery or laparoscopically and a wide variety of techniques are described

Question 6

Bochdalek hernia

Answer 6

Typically congenital diaphragmatic hernia
85% cases are located in the left hemi diaphragm
Associated with lung hypoplasia on the affected side
More common in males
Associated with other birth defects
May contain stomach
May be treated by direct anatomical apposition or placement of mesh. In infants that have severe respiratory compromise mechanical ventilation may be needed and mortality rate is high

Question 7

Morgagni hernia

Answer 7

Rare type of diaphragmatic hernia (approx 2% cases)
Herniation through foramen of Morgagni
Usually located on the right and tend to be less symptomatic
More advanced cases may contain transverse colon
As defects are small pulmonary hypoplasia is less common
Direct anatomical repair is performed

Question 8

Umbilical hernia

Answer 8

Hernia through weak umbilicus
Usually presents in childhood
Often symptomatic
Equal sex incidence
95% will resolve by the age of 2 years
Surgery performed after the third birthday

Question 9

Paraumbilical hernia

Answer 9

Usually a condition of adulthood
Defect is in the linea alba
More common in females
Multiparity and obesity are risk factors
Traditionally repaired using Mayos technique - overlapping repair, mesh may be used though not if small bowel resection is required owing to acute strangulation

Question 10

Littres hernia

Answer 10

Hernia containing Meckels diverticulum

Resection of the diverticulum is usually required and this will preclude a mesh repair