Hernias

Question 1

What is the classical surgical definition of a hernia?

Answer 1

The protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it.

Question 2

What are the risk factors for abdominal wall hernias?

Answer 2

Obesity, ascites, increasing age, surgical wounds.

Question 3

What are the common features of abdominal wall hernias?

Answer 3

Palpable lump, cough impulse, pain, obstruction, strangulation.

Question 4

Which type of hernia accounts for 75% of abdominal wall hernias?

Answer 4

Inguinal hernia

Around 95% of patients are male; men have around a 25% lifetime risk of developing an inguinal hernia.

Question 5

Where is an inguinal hernia located?

Answer 5

Above and medial to the pubic tubercle.

Question 6

What is the risk of strangulation in inguinal hernias?

Answer 6

Strangulation is rare.

Question 7

Where is a femoral hernia located?

Answer 7

Below and lateral to the pubic tubercle.

Question 8

Who is more likely to develop a femoral hernia?

Answer 8

More common in women, particularly multiparous ones.

Question 9

What is the risk associated with femoral hernias?

Answer 9

High risk of obstruction and strangulation.

Question 10

What characterizes an umbilical hernia?

Answer 10

Symmetrical bulge under the umbilicus.

Question 11

What characterizes a paraumbilical hernia?

Answer 11

Asymmetrical bulge - half the sac is covered by skin of the abdomen directly above or below the umbilicus.

Question 12

What is an epigastric hernia?

Answer 12

Lump in the midline between umbilicus and the xiphisternum.

Question 13

What are the risk factors for an epigastric hernia?

Answer 13

Extensive physical training or coughing (from lung diseases), obesity.

Question 14

What is an incisional hernia?

Answer 14

May occur in up to 10% of abdominal operations.

Question 15

What is a Spigelian hernia?

Answer 15

Also known as lateral ventral hernia, rare and seen in older patients.

Question 16

What characterizes an obturator hernia?

Answer 16

A hernia which passes through the obturator foramen, more common in females.

Question 17

What is a Richter hernia?

Answer 17

A rare type of hernia where only the antimesenteric border of the bowel herniates through the fascial defect.

Question 18

How can Richter’s hernia present?

Answer 18

Can present with strangulation without symptoms of obstruction.

Question 19

What is a congenital inguinal hernia?

Answer 19

Indirect hernias resulting from a patent processus vaginalis.

Question 20

How common are congenital inguinal hernias in term babies?

Answer 20

Occur in around 1% of term babies, more common in premature babies and boys.

Question 21

What is the typical presentation of infantile umbilical hernia?

Answer 21

Symmetrical bulge under the umbilicus.

Question 22

What is the prognosis for infantile umbilical hernias?

Answer 22

The vast majority resolve without intervention before the age of 4-5 years.

Question 23

What is a femoral hernia?

Answer 23

A femoral hernia occurs when a section of the bowel or any other part of the abdominal viscera passes into the femoral canal.

Question 24

Where is the femoral canal located?

Answer 24

The femoral canal is usually a densely packed area of the anterior thigh, but it is a potential space that can become occupied by herniated contents via the femoral ring.

Question 25

What are the key features of a femoral hernia?

Answer 25

A lump within the groin that is usually mildly painful; it is inferolateral to the pubic tubercle and typically non-reducible.

Question 26

How does a femoral hernia differ from an inguinal hernia?

Answer 26

Femoral hernias are inferolateral to the pubic tubercle, while inguinal hernias are supermedial to the pubic tubercle.

Question 27

What is the epidemiology of femoral hernias?

Answer 27

Femoral hernias are much less common than inguinal hernias (only 5% of abdominal hernias) and are more common in women (M:F 1:3).

Question 28

Why are femoral hernias more common in multiparous women?

Answer 28

The effects of increased abdominal pressure in pregnancy mean that femoral hernias are more common in multiparous women compared to nulliparous women.

Question 29

How is a femoral hernia diagnosed?

Answer 29

Diagnosis is usually clinical, although ultrasound is an option.

Question 30

What are important differentials to exclude for femoral hernias?

Answer 30

Lymphadenopathy, abscess, femoral artery aneurysm, hydrocoele or varicocele in males, lipoma, inguinal hernia.

Question 31

What are the complications of femoral hernias?

Answer 31

Complications include incarceration, strangulation, bowel obstruction, and bowel ischaemia.

Question 32

What is the risk associated with femoral hernias?

Answer 32

The risk of strangulation is much higher with femoral hernias than inguinal hernias and increases with time from diagnosis.

Question 33

What is the management for femoral hernias?

Answer 33

Surgical repair is necessary, either laparoscopically or via laparotomy; hernia support belts/trusses should not be used.

Question 34

What should be done in an emergency situation for femoral hernias?

Answer 34

In an emergency situation, a laparotomy may be the only option.

Question 35

What percentage of abdominal wall hernias are inguinal hernias?

Answer 35

Inguinal hernias account for 75% of abdominal wall hernias.

Question 36

What is the lifetime risk of developing an inguinal hernia in men?

Answer 36

Men have around a 25% lifetime risk of developing an inguinal hernia.

Question 37

What are the common features of an inguinal hernia?

Answer 37

Common features include a groin lump, superior and medial to the pubic tubercle, which disappears on pressure or when the patient lies down, and discomfort or ache that is often worse with activity.

Question 38

Is severe pain common in inguinal hernias?

Answer 38

Severe pain is uncommon.

Question 39

Is strangulation common in inguinal hernias?

Answer 39

Strangulation is rare.

Question 40

What is the current clinical consensus on treating inguinal hernias?

Answer 40

The consensus is to treat medically fit patients even if they are asymptomatic.

Question 41

What is a hernia truss?

Answer 41

A hernia truss may be an option for patients not fit for surgery but probably has little role in other patients.

Question 42

What type of repair is associated with the lowest recurrence rate for inguinal hernias?

Answer 42

Mesh repair is associated with the lowest recurrence rate.

Question 43

How are unilateral inguinal hernias generally repaired?

Answer 43

Unilateral inguinal hernias are generally repaired with an open approach.

Question 44

How are bilateral and recurrent inguinal hernias generally repaired?

Answer 44

Bilateral and recurrent inguinal hernias are generally repaired laparoscopically.

Question 45

What is the recommended return to work time after an open repair of an inguinal hernia?

Answer 45

Patients are recommended to return to non-manual work after 2-3 weeks.

Question 46

What is the recommended return to work time after a laparoscopic repair of an inguinal hernia?

Answer 46

Patients are recommended to return to non-manual work after 1-2 weeks.

Question 47

What are early complications of inguinal hernia repair?

Answer 47

Early complications include bruising and wound infection.

Question 48

What are late complications of inguinal hernia repair?

Answer 48

Late complications include chronic pain and recurrence.

Question 49

What is an inguinal hernia?

Answer 49

An inguinal hernia is the protrusion of viscera or abdominal contents through the superficial inguinal ring.

Question 50

What typically makes up the viscera in an inguinal hernia?

Answer 50

The viscera is normally made up of some small bowel, but not always.

Question 51

How can inguinal hernias enter the inguinal canal?

Answer 51

Inguinal hernias can enter the inguinal canal either directly through the deep inguinal ring or indirectly through the posterior wall.

Question 52

What does it mean for a hernia to be reducible?

Answer 52

A reducible hernia means that the herniated tissue can be pushed back into place in the abdomen through the defect using a hand.

Question 53

What is an incarcerated hernia?

Answer 53

An incarcerated hernia is one that cannot be reduced and is at risk of strangulation.

Question 54

What are the characteristics of incarcerated hernias?

Answer 54

Incarcerated hernias are typically painless.

Question 55

What is strangulation in the context of hernias?

Answer 55

Strangulation is a surgical emergency where the blood supply to the herniated tissue is compromised, leading to ischemia or necrosis.

Question 56

What is the risk associated with strangulation of inguinal hernias?

Answer 56

Impaired blood flow can cause bowel tissue to be permanently lost or to perforate.

Question 57

How common is strangulation in inguinal hernias?

Answer 57

Strangulation occurs in around 1 in 500 cases of all inguinal hernias.

Question 58

What are indications that a hernia is at risk of strangulation?

Answer 58

Indications include episodes of pain in a hernia that was previously asymptomatic and irreducible hernias.

Question 59

What are the symptoms of strangulated hernias?

Answer 59

Symptoms include pain, fever, increase in size of the hernia or erythema of the overlying skin, peritonitic features, bowel obstruction, and bowel ischemia.

Question 60

What imaging techniques can be used for suspected strangulation?

Answer 60

Imaging can include abdominal X-ray or CT, especially if obstruction is suspected.

Question 61

What laboratory tests can help in diagnosing strangulated hernias?

Answer 61

A full blood count and arterial blood gas analysis can show leukocytosis and raised lactate.

Question 62

What is the recommended repair method for strangulated hernias?

Answer 62

Repair involves immediate surgery, either from an open or laparoscopic approach with a mesh technique.

Question 63

What should not be done while waiting for surgery for strangulated hernias?

Answer 63

It is not recommended to manually reduce strangulated hernias, as this can cause more generalized peritonitis.

Question 64

Types of abdominal wall hernias, and details

Answer 64

Question 65

Abdominal wall hernias in children

Answer 65