Tutorial - Hernias

Question 1

Define hernia

Answer 1

A weakness in the abdominal wall where an internal organ/fatty tissue protrudes through

Question 2

Below what line do you lose the posterior rectus sheath? What is the significance of losing the sheath?

Answer 2

Arcuate line Weakness below this line

Question 3

What is the arcuate line?

Answer 3

A horizontal line between the umbilicus and pubic symphysis that demonstrates the end of the posterior rectus sheath

Question 4

What are the common types of hernias?

Answer 4

Inguinal Femoral Para-umbilical Umbilical Epigastric

Question 5

What kind of incision is shown?

Answer 5

Rooftop incision

Question 6

What kind of incision is shown?

Answer 6

Midline

Question 7

What is incision 1 known as?

Answer 7

Kocher incision

Question 8

What kind of incision is commonly used for upper GI surgeries?

Answer 8

Rooftop incisions, e.g. gastrectomy, oesophagectomy

Question 9

What kind of incision is used for an open colectomy?

Answer 9

Kocher

Question 10

What type of hernias are there?

Answer 10

Primary

Incisional

Question 11

What is an incisional hernia?

Answer 11

A hernia that occurs through a previously made incision in the abdominal wall

Question 12

What are RFs for primary hernias?

Answer 12

Increased abdominal pressure

Obesity

Question 13

What are RFs for incisional hernias?

Answer 13

Poor wound healing (e.g. DM, smoking, wound infection, steroids)

Technical problems, e.g. wrong sutures used

Question 14

What are symptoms of hernias?

Answer 14

Swelling + pain most common

Obstruction (if small bowel in hernia)

Reducible

Can become incarcerated/strangulated

Question 15

When are hernia swellings more noticible?

Answer 15

When you are standing up, better when lying

On coughing/increased intra-abdominal pressure

Question 16

What signs might you see in an incarcerated hernia?

Answer 16

Tachycardia due to pain

Question 17

What signs might you see in a strangulated hernia?

Answer 17

Pyrexia, tachycardia, skin changes e.g. cellulitis

Question 18

How do you investigate a hernia?

Answer 18

Clinical diagnosis

For more complex hernias may do CT to see contents of hernia

Question 19

How are hernias managed?

Answer 19

Surgical repair

Question 20

What does surgical repair of a hernia involve?

Answer 20

Suturing defect back together

Inserting mesh to prevent recurrence

Question 21

What are the risks of inserting mesh into a patient during hernia repair?

Answer 21

Infection (if bowel strangulated do not insert mesh as necrotic bowel puts risk of infection v. high)

Mesh rejection
Adhesions

Question 22

What are risks of hernia repair operations?

Answer 22

Adhesions

Infections

Seroma

Question 23

What are seromas?

Answer 23

A pocket of serous fluid that sometimes develops after surgery

Question 24

How are seromas avoided?

Answer 24

Drains inserted

Question 25

How can seromas be managed?

Answer 25

Conservatively - body resorbs fluid itself Aspiration

Question 26

What are differentials for groin abscesses?

Answer 26

Abscess (?IVDA) Lympadenopathy, e.g. reactive Testicular tumour Hydrocele

Question 27

Does inguinal hernia repair tend to be done open or laparoscopically?

Answer 27

Open

Question 28

Where is the superficial inguinal nerve situated?

Answer 28

Between the pubic symphysis and pubic tubercle

Question 29

Through what structure do the testes descend?

Answer 29

Inguinal canal

Question 30

Where is the deep inguinal ring situated?

Answer 30

Halfway between ASIS and pubic tubercle

Question 31

Where do inguinal hernias tend to be located?

Answer 31

Superior and medial to the pubic tubercle

Question 32

Where do femoral hernias tend to be situated?

Answer 32

Lateral and inferior to the pubic tubercle

Question 33

Who are femoral hernias more common in?

Answer 33

Elderly females

Question 34

Describe inguinal hernia surgery

Answer 34

Incision in groin Tie of superior epigastric vessels Divide external oblique to enter canal Reduce/excise contents of hernia Excise hernia sac Insert mesh Close EO

Question 35

What aponeurosis forms the anterior wall of the inguinal canal?

Answer 35

External oblique