Hernias

Question 1

What are the most common surgeries for hernias, from the most common to least?

Answer 1

Inguinal
Umbilical
Incisional
Femoral

Question 2

What are natural openings in the body that can herniate?

Answer 2

Inguinal, femoral, umbilicus, oesophageal hiatus and obturator.

Question 3

What are some natural areas that may stretch and herniate?

Answer 3

Epigastric and paraumbilical.

Question 4

What are two surgically induced hernias?

Answer 4

Incisional and parastomal.

Question 5

What can predispose people to hernias?

Answer 5

Heavy lifting, coughing, constipation, prostatism (enlarged prostate), pregnancy and obesity.

Question 6

What two categories do we divide hernias into?

Answer 6

Reducible and irreducible.

Question 7

What are the two different types of irreducible hernia?

Answer 7

Obstructed and incarcerated.

Question 8

What can happen to an obstructed hernia?

Answer 8

Strangulated.

Question 9

What is strangulation of a hernia?

Answer 9

Is due to compromise of blood supply of the contents. The low pressure venous system is occluded first and then the arterial supply becomes occluded, with the development of gangrene.

Question 10

What are the hernias of the abdominal wall?

Answer 10

Incisional, paraumbilical, epigastric paediatric umbilical, paediatric inguinal hernia, femoral and inguinal.

Question 11

What factors can contribute to the development of an incisional hernia?

Answer 11

Age, obesity and general debility e.g. Malignancy.

Post operative wound infection or haematoma, suturing technique and type of incision (vertical more than transverse).

Raised intra-abdominal pressure and steroids.

Question 12

What can we do to avoid an incisional hernia in predisposed patients?

Answer 12

Use tension sutures and mass close the linea alba.

Question 13

What three types of hydrocele hernias do we have?

Answer 13

Hydrocele of the cord, communicating hydrocele and hydrocele of the tunica vaginalis.

Question 14

What is a hydrocele?

Answer 14

A collection of fluid in the scrotum.

Question 15

What is an epigastric hernia?

Who most commonly gets them?

Answer 15

Arise from a congenital weakness of the linea alba, usually containing extra peritoneal fat.
Male 3:1 female.

Question 16

What are the symptoms of epigastric hernias and how do we repair them?

Answer 16

Usually Asymptomatic or local symptoms.

Repair with sutures or mesh.

Question 17

What is the treatment for congenital umbilical hernias?

Answer 17

Monitored to see if they resolve by the age of three, if aged over three then they will operate.

Question 18

What paediatric patients are more prone to having an inguinal hernia?

Answer 18

30% under the age of a year.
Male:female ratio is 9:1
More common in preterm and LBW infants.

Question 19

On What side are paediatric inguinal hernias more common?

Answer 19

Right sided more common.

Question 20

What are the complications of paediatric inguinal hernias?

Answer 20

20% chance of developing a contralateral hernia.

Increased risk of strangulation under the age of 1 and so they are urgently operated on.

Question 21

What kind of patients should we consider having a femoral hernia?

Answer 21

Thin elderly females. Look for a loss of groin crease.

Question 22

How much more common are femoral hernias in females than males?

Answer 22

10x

Question 23

What is the most common type of hernia?

Answer 23

Inguinal.

Question 24

What must we exclude when examining for an inguinal hernia?

Answer 24

Exclude scrotal swelling.

Question 25

How do we differentiate between an inguinal and femoral hernia on examination?

Answer 25

Examine upright. Find the pubic tubercle, if above and medial it is inguinal. If it below and lateral its femoral.

Question 26

How do we differentiate between direct and indirect inguinal hernias on examination?

Answer 26

Put pressure over the deep inguinal ring and ask the patient to cough. Place a little finger in the canal behind the cord and ask the patient to cough. If there is a palpable bulge this means there is an indirect hernia.

Question 27

How do we differentiate between an indirect and direct hernia in surgery?

Answer 27

Direct is medial to inferior epigastric vessels. | Indirect is lateral to inferior epigastric vessels.

Question 28

If a hernia reaches into the scrotum what type is it most likely to be?

Answer 28

Indirect.

Question 29

What type of inguinal hernias are congenital?

Answer 29

Indirect.

Question 30

Which inguinal hernias are often bilateral?

Answer 30

Direct.

Question 31

Where are the deep and superficial rings found in relation to the patients surface anatomy?

Answer 31

Deep - mid inguinal point. | Superficial - above and medial to the pubic tubercle.

Question 32

What is hesselbachs triangle?

Answer 32

Inguinal ligament inferiorly. Inferior epigastric vessels laterally. Lateral border of rectus sheath medially.

Question 33

What inguinal hernia is more common in younger men?

Answer 33

Indirect

Question 34

What inguinal hernia is more common in older men?

Answer 34

Direct

Question 35

When will we operate on an inguinal hernia?

Answer 35

Risk of complication even if Asymptomatic. Hernias with previous symptoms of obstruction. Hernia interfering with lifestyle.

Question 36

What are the complications of inguinal hernia?

Answer 36

``` Haematoma (wound or scrotum) Acute urinary retention. Wound infection. Chronic neurogenic pain Hernia recurrence Testicular pain and atrophy. ```

Question 37

What types of operations are done on inguinal hernias?

Answer 37

Suture e.g. Bassini. Open mesh e.g. Lichtenstein. Laparoscopic TAPS or TEPS (intraperitoneal or extraperitoneal).

Question 38

What are the post operative instructions after inguinal hernia operation?

Answer 38

No driving for a week and no heavy lifting for a month (1hand lift only)

Question 39

What is a herniotomy?

Answer 39

Excision of the peritoneal sac. | Done for congenital inguinal hernias.

Question 40

What is a herniorraphy?

Answer 40

Repair of the defect of the wall.

Question 41

What is a hernia?

Answer 41

An abnormal protrusion of viscous outwith it's normal body cavity.