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
