Hernias

Question 1

What are the most common Hernias ?

Answer 1

Inguinal, Incisional, Umbilical, and hiatus.

Question 2

What is reducible hernia ?

Answer 2

In reducible hernia contents re-enter the abdomen with manipulation or spontaneously.

Question 3

What is Irreducible or Incarcerated hernia ?

Answer 3

These are Hernias that persist despite trying to manipulate which can lead to obstruction and increases risk of strangulation.

Question 4

What is strangulated hernia ?

Answer 4

These are hernias at an increased risk of ischemai and necrosis.

Question 5

What are inguinal hernias ?

Answer 5

It is most common in men as the descent of the testis through the abdominal wall predisposes men to inguinal hernias. It Usually occur in association with congenitally patent processus vaginalis. 70% are direct and 30% are indirect.

Question 6

What is the cause of indirect inguinal hernia ?

Answer 6

Weakness of posterior abdominal wall.

Question 7

What is the presentation of inguinal hernia ?

Answer 7

It presents as lump in the groin and may be palpable on coughing as a lump on superficial inguinal ring. It usually reduces when the patient lay down. Severe complications strangulation which is a surgical emergency and is rare.

Question 8

What are the three vessels in the inguinal canal ?

Answer 8

– Testicular A&V
– A&V to the Vas
– Cremasteric A&V

Question 9

What are the three nerves in the inguinal canal ?

Answer 9

– Genital branch of genitofemoral
– Cremasteric
– illioinguinal
– (+ sympathetics)

Question 10

What are the three fasciae in the inguinal canal ?

Answer 10

– External spermatic
– Internal spermatic
– Cremasteric

Question 11

What are the 3 non vascular, non neural structures of the inguinal canal ?

Answer 11

– Spermatic cord
– Vas Deferens
– Lymphatics

Question 12

What is the management of inguinal hernia ?

Answer 12

• Conservative: Lifestyle modifications and Hernia belts/truss.
• Surgical: Laparoscopic Mesh Repair,
  *TAPP: TransAbdominal Pre-Peritoneal
• TEP: Totally Extra-Peritoneal
  – Open surgery: Patch of non-absorbable mesh strengthens posterior wall of inguinal canal.

Question 13

What are incisional hernias ?

Answer 13

These are herniation of abdominal content through the vertical surgical incisions. The patients often presents with pain and lumps that comes and goes during coughing or straining.

Question 14

What is the management of incisional hernia ?

Answer 14

• Conservative– Abdominal binder
• Open repair + mesh
• Laparoscopic repair + mesh

Question 15

What is the 2nd most common hernia ?

Answer 15

Umbalical hernia 90% acquired and 10% congenital. Common in females.

Question 16

risk factors for umbalical hernia ?

Answer 16

Obese, multiparous women, and ascites.

Question 17

What is the management of umbalical hernia ?

Answer 17

– Suture repair
– Open/Laparoscopic mesh repair

Question 18

What is the presentation of femoral hernia ?

Answer 18

They present within the femoral triangle and are common in woman. It is often a surgical emergency due to it getting strangulated within the narrow neck of the femoral canal.

Question 19

What is the location of inguinal hernia ?

Answer 19

Above and medial to public tubercle.

Question 20

What is the location of femoral hernia ?

Answer 20

Below and lateral to pubic tubercle.

Question 21

What is the deep ring test utility in reducible inguinal hernia ?

Answer 21

Occlude deep ring with 2 fingers while hernia reduced and ask the patient to cough. If the hernia reappears it is a direct hernia and if it does not reappear, it is an indirect hernia.