Inguinal Hernias Flashcards
What is a inguinal hernia
A protrusion of abdominal cavity contents into the inguinal canal
what is the most common type of hernia
Inguinal hernia ( 75% )
What are the two subtypes of inguinal hernias
Direct inguinal hernia - 20%
Indirect inguinal hernias - 80%
What happens in a direct inguinal hernia
Bowel enters the inguinal canal directly though a weakness in the posterior wall of the inguinal canal.
What are the borders of hesselbachs triangle
Lateral border of rectus abdominis
Inferior epigastric vessels
Inguinal ligament ( bit of lacunar ligament if you want to be picky)
Why do direct inguinal hernias occur
Abdominal wall laxity especially with increase in age
A significant rise in intra-abdominal pressure
Why do indirect inguinal hernias occur
Due to a incomplete closure of processus vaginalis
How are you able to differentiate between the direct and indirect hernias anatomically
Direct => medial to the inferior epigastric vessels
Indirect => lateral to the inferior epigastric vessels
what are the risk factors of developing inguinal hernias
Male
Increasing age
Raised intra-abdominal pressure - chronic cough, lifting heavy things, chronic constipation
Obesity
What are the clinical features of those with a reducible inguinal hernia that
Lump in the groin that disappears when patient lies flat or is pushed back by a doctor
what does a incarcerated hernia mean
A hernia that is stuck and cannot be reduced back to where it came from
How would a patient present if the hernia was incarcerated
Painful
Tender
Erythematous
Bowel obstruction
Strangulation
how do you clinically differentiate direct inguinal hernias from indirect
The hernia must first be reduced and then pressure over the deep inguinal ring must be applied.
Patient must then be asked to cough and if pressure is felt at the deep ring then this is a direct hernia. If pressure is not felt as the deep ring => indirect hernia
What is the inguinal ligament
Ligaments are from bone to bone and this one attaches from ASIS to the Pubic tubercle
What is the mid-inguinal point
Half way between the ASIS and pubic tubercle
This is where you can feel the femoral artery
What anatomical structure is found at the mid point of the inguinal ligament
Deep inguinal ring
What are the differentials for groin lump
Femoral hernia
Saphena varix
Inguinal lymphadenopathy
Lipoma
Groin abscess
Internal iliac aneurysm
How are inguinal hernias investigated
Usually a clinical diagnosis and patients may undergo exploratory surgery for definitive diagnosis
However USS may be performed if there is diagnostic uncertainty or to exclude other pathology
How would you treat a symptomatic inguinal hernia
Surgical intervention
How much is the risk of strangulation for a inguinal hernia that is not treated
3% per year
What are the two surgical options to treat hernias
Open ( Lichtenstein technique )
Laparoscopic ( Total extraperitoneal or transabdominal pre-peritoneal)
Which type of surgical repair is preferred in those with a primary inguinal hernia
Open mesh repairs
When is a laparoscopic approach preferred over open
Those pts with bilateral hernias / recurrent
It can also be considered in those who are at risk of chronic pain
What is the advantage of laparoscopic surgeries compared to open
Quicker post op recovery
Fewer complications
Less post op pain
Which types of hernias require urgent medical attention
Irreducible/incarcerated
Obstruction - bowel lumen is obstructed
Strangulation - leads to bowel ischaemia
What are the complications of inguinal hernias
Incarcerated
Strangulation
Obstruction
what are the post op complications of hernias
Pain, bruising, haematoma, infection, urinary retention.
Reoccurrence
Chronic pain
Damage to vas
