Inguinal Hernia Flashcards

1
Q

Explain inguinal hernia

A

When abdo cavity contents enter into the inguinal canal

Most common type of hernia and accounts for 75% of all anterior abdo wall hernias

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2
Q

Types of inguinal hernia

A

Direct

Indirect

(Management will be the same regardless of type)

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3
Q

Explain direct inguinal hernia

A

Bowel enters the inguinal canal directly through a weakness in the posterior wall of the canal

Hesselbach’s triangle

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4
Q

Explain Indirect inguinal hernia

A

Bowel enters the inguinal canal via the deep inguinal ring.

Arise from incomplete closure of the processus vaginalis.

Usually deemed congenital in origin.

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5
Q

How can the two be differentiated?

A

Indirect = lateral to inferior epigastric vessel

Direct = medial to inferior epigastric vessel

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6
Q

Risk factors

A

Male

Increasing age

Raised abdo pressure from chronic cough, chronic constipation or heavy lifting

Obesity

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7
Q

Clinical features

A

Lump in the groin that will initially disappear with minimal pressure or when the patient lies down

Can be mild-moderate discomfort on activity or standing.

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8
Q

Clinical features of incarcerated inguinal hernia

A

Painful

Tender

Erythematous

Might also have features of bowel obstruction or strangulation

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9
Q

Examinations of inguinal hernia

A

Cough impulse (irreducible hernia may not have cough impulse)

Location - superiomedial to the pubic tubercle

Reducible - only lying down +/- minimal pressure

If it enters the scrotum -> can you get above it / is it separate from the testis?

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10
Q

Examination to differentiate between direct and indirect.

A

Reduce the hernia

Place pressure on the deep inguinal ring and ask the patient to cough.

If the hernia protrudes -> direct hernia

If it does not protrude -> indirect

This assessment is often unreliable.

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11
Q

Dx

A

Femoral hernia

Saphena varix

Inguinal lymphadenopathy

Lipoma

Groin abscess

Internal iliac aneurysm

Hydrocoele

Varicocoele

Testicular mass

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12
Q

Ix

A

Clinical diagnosis

Imaging should only be considered if there is diagnostic uncertainty or to exclude other pathology.

First line imaging is ultrasound scan

Features of obstruction or strangulation requires CT scan.

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13
Q

Management of symptomatic inguinal hernia like significant mass or discomfort

A

Surgical intervention

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14
Q

Risk of strangulation

A

Approx 3% per year

If there is evidence of strangulation this requires urgent surgical exploration

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15
Q

Surgical approaches

A

Open mesh repair (Lichtenstein technique) most commonly used

Laparoscopic repair (Total extraperitoneal (TAP) or transabdominal pre-peritoneal (TAPP))

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16
Q

Explain open mesh repai

A

Preferred for those with primary inguinal hernias and deemed most cost-effective in this patient group.

Can be performed under general, spinal or local anaesthesia.

17
Q

Explain laparoscopic repair

A

Preferred in bilateral or recurrent inguinal hernias

Also in primary unilateral hernia in high risk of chronic pain (young active, previous chronic pain) or in females.

Longer operating times but quicker post-op recovery, fewer complications and less post-op pain.

18
Q

Complications

A

Incarceration

Strangulation

Obstruction

19
Q

Post-op complications

A

Pain, bruising, haematoma

Infection or urinary retention

Recurrence

Chronic pain

Damage to vas def or testicular vessels leading to ischaemic orchitis