Inguinal Hernias

Question 1

List the types of Inguinal Hernias

Answer 1

Indirect inguinal - hernia through inguinal canal due to patent processus
vaginalis
○ Direct inguinal hernia - direct through abdominal wall into the scrotum, most
common hernia in men and women.
○ Femoral hernia - hernia under inguinal ligament, medial to femoral vessels
with swelling below inguinal ligament. More common in women
○ Obturator hernia - through obturator canal with vessels and nerves, medial
thigh swelling. More in women due to weak pelvic floor.
○ Cooper hernia - through femoral canal tracking into the scrotum or labia
○ Pantaloon hernia: Both direct and indirect hernia.

Question 2

What is the difference between Incarcerated and strangulated Hernias?

Answer 2

Incarcerated hernias are not reducible.
Strangulated hernias are incarcerated hernias that are now being strangled (deprived of blood flow) thus red or bluish.
Strangulated hernias are a surgical emergency.

Question 3

What are the borders of the inguinal Hernia?

Answer 3

External oblique aponeurosis is the anterior wall.
Inguinal ligament is the inferior wall.
Conjoint tendon (internal oblique and transversus muscles) is roof.
Transversalis fascia and aponeurosis are the floor.

Question 4

List the reasons for development of post-surgical Hernias

Answer 4

Decreased healing ability due to DM
Immune suppression
Age, obesity, skin ulceration
Increased intra-abdominal pressure due to constipation or ascites
Periumbilical hernia - umbilical scar healing issue
Epigastric - linea alba defect
Diastasis recti - rectus muscles too widely separated
Incisional hernia - post op typically midline or transverse incisions
Parastomal - due to poor site selection or error in stoma placement