Management of hernias Flashcards
Can umbilical hernias close spontaneously?
Yes - if <2-3mm in size
Can close spontaneously up to the age of 6 months old
Why should animals be neutered when repairing an umbilical hernia?
Inherited defect
All umbilical hernias with risk of strangulation/incarceration should be repaired. What size hernias are at risk?
10+ mm in diameter
With an inelastic ring
The history of a patient with an inguinal hernia may help with working out the contents. What organ would you suspect to be herniated if the history includes vomiting, pain and depression?
Intestines
The history of a patient with an inguinal hernia may help with working out the contents. What organ would you suspect to be herniated if the history includes vaginal bleeding and discharge?
Uterus
How soon after diagnosis should an inguinal hernia be treated?
ASAP
What are the 2 incision approaches when repairing an inguinal hernia?
Direct over hernia - if uncomplicated
Midline incision +/- coeliotomy - if complicated
Give examples of a ‘complicated hernia’
Incarcerated/strangulated contents
Herniated uterus
Significant trauma
Bilateral hernia
When repairing an inguinal hernia, how can you re-inforce the repair?
Polyethylene mesh
Sartorius muscle flap
What are some complications of inguinal hernia repair?
Infection
Haematoma/seroma
Pain and reluctance to walk
Compression of vessels/nerves
How can a haematoma/seroma of a wound be prevented?
With dressings or placing drains
How soon after diagnosing a traumatic hernia should it be repaired?
Delay surgery for a few days if possible
May have to perform emergency surgery
Why is it best to delay surgery for a few days after a traumatic hernia?
Improves blood supply
Reduced oedema nad haemorrhage
(But XS delay = adhesions, incarceration, fibrosis)
When is emergency surgery after a traumatic hernia necessary?
If patient cannot be stabilised
Patient deteriorates
Penetrating abdominal wound present
Strangulating hernia
How does the approach to repair of a traumatic hernia differ based on whether it is acute or chronic?
Chronic hernias - incision over hernia ring
Acute hernias - ventral midline coeliotomy
How should acute, uncomplicated incisional hernia repairs be approached surgically?
Reopen original incision
How should acute, complicated incisional hernia repairs be approached surgically?
Ventral midline coeliotomy
How should chronic incisional hernias be treated if they are asymptomatic or have no incarceration?
Conservative management
What can be seen on a thorax radiograph of a peritoneopericardial diaphragmatic hernia?
Enlarged/rounded cardiac silhouette
Overlapping diaphragm/cardiac silhouette
Abnormal soft tissue density in pericardium (intestines)
How should chronic incisional hernias be treated if the patient has symptoms?
Incision over original line
How should peritoneopericardial diaphragmatic hernias be treated if they are asymptomatic?
Conservative
How should peritoneopericardial diaphragmatic hernias be treated if the patient is symptomatic?
Surgery via ventral midline coeliotomy
How soon after trauma should diaphragmatic hernias be repaired?
As soon as patient is stable
Complex - consider referral
Which type of hernia may require a few days before surgery for optimum success?
Traumatic hernias
But diaphragmatic should be as soon as stable
What surgical procedure should be performed to treat perineal hernias?
Internal obturator transposition
Complications occur in up to 50% of perineal hernias that undergo internal obturator transposition. What is the most common complication?
Wound infection
