Hernias

Question 1

Indirect Hernia

Answer 1

• Congenital
• patent processus vaginalis; Lateral to epigastric vessels; protrude with spermatic cord into scrotum
• Most common in all sexes
• Complications: incarceration -> obstruction + strangulation; scrotal hernia; hydrocele

Question 2

Direct inguinal Hernia

Answer 2

• Directly through posterior inguinal wall
• Medial to epigastric vessels; Do NOT protrude with cord; reduces spontaneously
• More common in Older men

Question 3

Femoral Hernia

Answer 3

• More common in females; acquired; Below inguinal ring
• Et: Short medial attachment of transversus abdominus into Coopers ligament -> enlarged femoral ring
• very susceptible to incarceration + strangulation

Question 4

Infant Umbilical herniation

Answer 4

• resolves spontaneously
• incomplete closure of abdominal wall
• folk remedies delay closure

Question 5

Omphalocele

Answer 5

• Organs are herniated in thin peritoneal membrane + Amnion

Question 6

Gastroschisis

Answer 6

• Severe failure of abdominal wall closure due to lateral wall defect
• Organs herniate into amniotic cavity with NO sac

Question 7

Spigelian hernia

Answer 7

• Herniation through semilunar line; lateral margin of rectur muscle at or below smicircular line of Douglas
• Cephalad to inferior epigastric vessels

Question 8

Grynfelt’s Hernia

Answer 8

• Wide-mouth hernia protruding through superior lumbar triangle (Superior lumbar spine; internal obliques; inferior margin 12th rib)
• Often diagnosis hampered by Latissimus Dorsi

Question 9

Petits Hernia

Answer 9

• Infeiror Lumbar triangle (lateral margin Lats, Medial External obliques, + Iliac Crest)

Question 10

Richter’s Hernia

Answer 10

• hernia at any site through which only a portion of the circumference of a bowel wall, usually jejunum, incarcerates or strangulates
• Symptoms of bowel obstruction can be absent

Question 11

Littre’s Hernia

Answer 11

• Groin hernia w/ Meckel’s Diverticulum

- Usually incarcerated/strangulated

Question 12

Obturator Hernia

Answer 12

• Hernia through obturator canal
• often Richters type
• Howship-Romberg Sign: Bowel obstruction + paresthesia on anteromedial thigh (Obturator compression)

Question 13

Pantaloon Hernia

Answer 13

Indirect + Direct simultaneous Hernia

Question 14

Sliding Hernia

Answer 14

• any hernia which a portion of the wall of protruding peritoneal sac is made up of some intraabdominal organ, which, as the sac expands, gets drawn out into the hernia

Question 15

Sliding Hernia Triad

Answer 15

• Scrotal swelling
• Irreducible
• No strangulation

Question 16

Prevalence of Hernias

Answer 16

• 3% Genpop

- M:F 25:1

Question 17

Sx repair of hernia

Answer 17

1. Reduce abdominal viscus to cavity
2. obliterate processus vaginalis
3. Reform snug abdominal ring around spoermatic cord by anchoring remnant of posterior wall back to anatomic insertions into Coopers ligament + anterior femoral sheath

Question 18

Drawback of synthetic materials for hernia repair

Answer 18

Infections are more severe although less frequent

Question 19

Drawbacks of Lichenstein common tension-free repair

Answer 19

• suture intensive
• No Posterior support
• No protection of femoral canal

Question 20

Drawbacks of Lap Hernia tension free repair

Answer 20

• More challenging
• general anesthesia
• Cost