Herniorraphy Flashcards
What is a hernia?
A prolapse of an organ or part of the organ through an abnormal opening in the wall of the anatomical cavity in which it normally lies
What does a hernia consist of?
- A defect - the hernial ring
- A lining - the hernial sac
- Hernial contents
What is a true hernia?
One with a hernial sac
e.g. umbilical hernia
What is a false hernia?
One that doesn’t have a hernial sac
e.g. traumatic diaphragmatic hernia
How do you classify a hernia?
Based on:
- Etiology
- Congenital vs. Acquired
- Contents
- Whether its reducible or irreducible
- Location
What is the difference between reducible and irreducible hernias?
Reducible: Hernia in which the content can be returned to the abdomen
Irreducible: A hernia in which content has become adherent to the sac and can’t be returned to the abdomen
OR
Has become too odematous or enlarged to be reduced back through the hernial ring
What can irreducible hernias be divided into?
- Strangulated and Incarcerated hernias
Describe Strangulated hernias…
Where there has been an obstruction to the circulation of the contents of the hernial sac
- Contents rapidly become gangrenous
- Usually affects the venous supply first
- can affect the arterial supply and rapidly go gangrenous
Describe Incarcerated hernias…
Contents have a normal blood supply but can’t return to the abdomen
- e.g. pregnant uterus in inguinal hernia in bitches
List the locations of hernias from most to least common…
- Umbilical
- Inguinal
- Diaphragmatic
- Perineal (only males)
- Ventral
- Internal
- Femoral
What are the 10 basic principles of herniorrhaphy?
- Determine the urgency of repair
- Palpate to determine extent and severity
- Identify strangulation or incarceration
- Triage patient
- Plan approach
- Remove redundant skin
- Accurate identification of layers
- Separation of adhered hernial sac
- Invagination or resection of sac
- Careful approximation of layers
What are the signs of a strangulated hernia?
- Sudden increase in the size of the hernia
- Painful to palpate
- Becomes firm, warm and oedematous
- Skin may become red/bluish
- Colic signs may occur
Describe the closure of a hernia…
Goal is for permanent repair
- Use long lasting absorbable or nonabsorbable e.g. nylon
- Interrupted pattern preferred due to strength and multiple loops
- Muscle flap techniques, bone anchoring and mesh repair can be used
- Sutures must be placed without tension
Describe an umbilical hernia?
A protrusion of omentum, falciform ligament or any other viscera through an open umbilical ring
Variable size
Congenital; common in horses, pigs, cattle and dogs
By be inherited or environmental; failure of abdominal muscle plates to entirely close
Heritability varies between species
Why aren’t all umbilical hernias surgically corrected ASAP?
Surgical correction should be delayed until maturity because spontaneous closure can occur
- Unless strangulated
What is an overlapping hernia correction?
When you try to oppose the two edges by overlapping
- to get a better seal and better healing
- good for large hernias or those under more tension
Describe an inguinal (scrotal) hernia
- Only males
- Can become scrotal
- Very common in pigs
- Common in colts
- Uncommon in dogs
- Heritable weakness/ enlargement of the inguinal ring
- Hernia may occur later due to stress of mating etc
Describe direct inguinal hernias…
Pass through internal inguinal ring adjacent to normal inguinal structures which are enclosed in the vaginal tunic
Describe indirect inguinal hernias…
Involve the abdominal contents entering the inguinal canal within the vaginal tunic
- Most common inguinal hernia found in small animals, pigs and horses
What are some other DDx for inguinal hernias?
Lymphadenopathy
Neoplasia
Abscess
What is the operative technique for Inguinal hernia correction?
- Surgery urgent if strangulated
- Closed castration in males
- Milk and amputate the sac
- Additional sutures to close the external inguinal ring
- leave room for the external pudendal vessels and the genitourinary nerve
- Midline coeliotomy may be required in some species to perform reduction
Describe a ventral hernia…
A rupture of the abdominal wall through an unnatural opening e.g. a sharp poke hole
Hernia may be present on any part of the abdominal wall
Traumatic or Femoral
- as a result of trauma may need to triage patient
May result from rupture of the prepubic tendon anchored to the pelvis or a free floating pubic fracture
What questions could you ask yourself when presented with a potential hernia case?
- What sort of hernia is likely present?
- Is it a true or false hernia?
- Why is it painful now?
- What organs may be the contents of the hernia?
- If it isn’t a hernia, what else could it be?
- What tests could you use to determine if it’s a hernia
