Hernias

Question 1

What is an inguinal hernia?

Answer 1

Hernia above and medial to pubic tubercle

Question 2

What is an incarcerated hernia?

Answer 2

Hernias that are not reducible, meaning that the herniated tissue is unable to be pushed back into place in the abdomen through the defect using a hand

Incarcerated hernias are at risk of strangulation

Question 3

What is a strangulated hernia?

Answer 3

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

As most inguinal hernias are formed from small bowel, this impaired blood flow can cause the bowel tissue to be permanently lost or to perforate

Question 4

How do strangulated hernias present?

Answer 4

Irreducible and tender lump

Fever

Increase in the size of a hernia

Erythema of the overlying skin

Featutures of peritonitic features such as guarding and localised tenderness

Features of bowel obstruction such as distension, nausea, vomiting

Features of bowel ischemia such as bloody stools

Question 5

How are strangulated hernias managed?

Answer 5

Immediate surgery, either from an open or laparoscopic approach with a mesh technique

While waiting for the surgery, it is not recommended that you manually reduce strangulated hernias, as this can cause more generalised peritonitis.

Question 6

How do inguinal hernias present?

Answer 6

Groin lump/scrotum swelling

• Disappears on pressure or when the patient lies down

Discomfort and ache

• Often worse with activity, severe pain is uncommon

Does not transilluminate

Ability to palpate above mass

Question 7

What side are inguinal hernias most likely to occur?

Answer 7

R>L

Question 8

How are inguinal hernias managed?

Answer 8

Surgical repair via mesh repair

• <6 weeks, within 2 days
• 6 weeks-6 months, within 2 weeks
• >6 months, within >2 months

Question 9

What sex are inguinal hernias most common?

Answer 9

M>F

95% of patients are male and have around a 25% lifetime risk of developing an inguinal hernia

Question 10

Give complications of inguinal hernias

Answer 10

Irreducibility

• Hernia cannot be pushed back into original cavity

Incarceration

• Irreducibility with resultant tissue necrosis of either testis or bowel

Bowel obstruction

• Due to incarceration

Question 11

What is a femoral hernia?

Answer 11

Hernia below and lateral to the pubic tubercle

Question 12

What sex are femoral hernias more common in?

Answer 12

F>M

Question 13

Which hernia is strangulation more common?

Answer 13

Femoral

Question 14

What factors increase risk of paediatric hernias?

Answer 14

Prematurity

Question 15

What are the types of paediatric inguinal hernias?

Answer 15

Direct

• Patent processus vaginalis

Indirect

Question 16

Describe management of paediatric inguinal hernias

Answer 16

• < 6 weeks old correct within 2 days
• < 6 months correct within 2 weeks
• < 6 years correct within 2 months

Question 17

Describe management of paediatric umbillical hernias

Answer 17

No treatment is required as usually will resolve by 3 years