Inguinal Hernia

Question 1

Commonest type of hernia

Answer 1

Inguinal Hernia

Question 2

Inguinal Hernia

Answer 2

Abdominal cavity contents enter into the inguinal canal.

Question 3

Types for inguinal hernia

Answer 3

Indirect

• through deep inguinal ring
• lateral to inferior epigastric vessels

Direct - through Hesselbach’s triangle
- medial to inferior epigastric vessels

Question 4

Risk Factors for inguinal hernia

Answer 4

Male

Increasing age

Raised intra-abdominal pressure:

• chronic cough
• heavy lifting
• chronic constipation

Obesity

Question 5

Clinical Features for inguinal hernia

Answer 5

Lump in the groin

- disappear with minimal pressure or when lying down

Question 6

Incarcerated hernia presentation

Answer 6

Painful 
Irreducible
Tender 
Erythematous 
Bowel obstruction

Question 7

Examining any groin lump

Answer 7

Cough impulse
Location to pubic tubercle
Reducible
Enters the scrotum - can you get above it

Question 8

Investigations for inguinal hernia

Answer 8

Abdominal examination

Obs

Bloods - CRP

USS - first line

If obstruction or strangulation - CT

Question 9

Management for inguinal hernia

Answer 9

Symptomatic inguinal hernia:

Surgical intervention:
- Open repair - Lichtenstein technique

• laparoscopic repair - either total extraperitoneal (TEP) or transabdominal pre-peritoneal (TAPP)
• Open mesh repair

Question 10

When is laparoscopic preferred

Answer 10

High risk of chronic pain:

• young and active
• previous chronic pain

Female
Primary bilateral hernia
Recurrent hernia

Question 11

Emergency Management of a Hernia

Answer 11

Irreducible / incarcerated – the contents of the hernia are unable to return to their original cavity

Obstruction

Strangulation – compression of the hernia has compromised the blood supply, leading to ischaemia

Question 12

Femoral hernia

Answer 12

Abdominal viscera or omentum passes through the femoral ring and into the potential space of the femoral canal

High rate of strangulation

Question 13

Risk factors for developing a femoral hernia

Answer 13

Female

Pregnancy

Raised intra-abdominal pressure (e.g. heavy lifting, chronic constipation)

Increasing age

Question 14

Management of femoral hernias

Answer 14

Managed surgically, within 2 weeks of presentation

Question 15

Approaches to femoral hernia surgical reduction

Answer 15

Low approach – incision below inguinal ligament

• not interfering with the inguinal structures
• limited space for the removal of any compromised small bowel

High approach – incision above inguinal ligament

• preferred emergency technique
• easy access to compromised small bowel