Herniorraphy

Question 1

What is a hernia?

Answer 1

A prolapse of an organ or part of the organ through an abnormal opening in the wall of the anatomical cavity in which it normally lies

Question 2

What does a hernia consist of?

Answer 2

• A defect - the hernial ring
• A lining - the hernial sac
• Hernial contents

Question 3

What is a true hernia?

Answer 3

One with a hernial sac

e.g. umbilical hernia

Question 4

What is a false hernia?

Answer 4

One that doesn’t have a hernial sac

e.g. traumatic diaphragmatic hernia

Question 5

How do you classify a hernia?

Answer 5

Based on:

• Etiology
• Congenital vs. Acquired
• Contents
• Whether its reducible or irreducible
• Location

Question 6

What is the difference between reducible and irreducible hernias?

Answer 6

Reducible: Hernia in which the content can be returned to the abdomen

Irreducible: A hernia in which content has become adherent to the sac and can’t be returned to the abdomen
OR
Has become too odematous or enlarged to be reduced back through the hernial ring

Question 7

What can irreducible hernias be divided into?

Answer 7

• Strangulated and Incarcerated hernias

Question 8

Describe Strangulated hernias…

Answer 8

Where there has been an obstruction to the circulation of the contents of the hernial sac

• Contents rapidly become gangrenous
• Usually affects the venous supply first
• • can affect the arterial supply and rapidly go gangrenous

Question 9

Describe Incarcerated hernias…

Answer 9

Contents have a normal blood supply but can’t return to the abdomen
- e.g. pregnant uterus in inguinal hernia in bitches

Question 10

List the locations of hernias from most to least common…

Answer 10

• Umbilical
• Inguinal
• Diaphragmatic
• Perineal (only males)
• Ventral
• Internal
• Femoral

Question 11

What are the 10 basic principles of herniorrhaphy?

Answer 11

1. Determine the urgency of repair
2. Palpate to determine extent and severity
3. Identify strangulation or incarceration
4. Triage patient
5. Plan approach
6. Remove redundant skin
7. Accurate identification of layers
8. Separation of adhered hernial sac
9. Invagination or resection of sac
10. Careful approximation of layers

Question 12

What are the signs of a strangulated hernia?

Answer 12

• Sudden increase in the size of the hernia
• Painful to palpate
• Becomes firm, warm and oedematous
• Skin may become red/bluish
• Colic signs may occur

Question 13

Describe the closure of a hernia…

Answer 13

Goal is for permanent repair

• Use long lasting absorbable or nonabsorbable e.g. nylon
• Interrupted pattern preferred due to strength and multiple loops
• Muscle flap techniques, bone anchoring and mesh repair can be used
• Sutures must be placed without tension

Question 14

Describe an umbilical hernia?

Answer 14

A protrusion of omentum, falciform ligament or any other viscera through an open umbilical ring

Variable size

Congenital; common in horses, pigs, cattle and dogs

By be inherited or environmental; failure of abdominal muscle plates to entirely close

Heritability varies between species

Question 15

Why aren’t all umbilical hernias surgically corrected ASAP?

Answer 15

Surgical correction should be delayed until maturity because spontaneous closure can occur
- Unless strangulated

Question 16

What is an overlapping hernia correction?

Answer 16

When you try to oppose the two edges by overlapping

• to get a better seal and better healing
• good for large hernias or those under more tension

Question 17

Describe an inguinal (scrotal) hernia

Answer 17

• Only males
• Can become scrotal
• Very common in pigs
• Common in colts
• Uncommon in dogs
• Heritable weakness/ enlargement of the inguinal ring
• Hernia may occur later due to stress of mating etc

Question 18

Describe direct inguinal hernias…

Answer 18

Pass through internal inguinal ring adjacent to normal inguinal structures which are enclosed in the vaginal tunic

Question 19

Describe indirect inguinal hernias…

Answer 19

Involve the abdominal contents entering the inguinal canal within the vaginal tunic
- Most common inguinal hernia found in small animals, pigs and horses

Question 20

What are some other DDx for inguinal hernias?

Answer 20

Lymphadenopathy
Neoplasia
Abscess

Question 21

What is the operative technique for Inguinal hernia correction?

Answer 21

• Surgery urgent if strangulated
• Closed castration in males
• Milk and amputate the sac
• Additional sutures to close the external inguinal ring
• • leave room for the external pudendal vessels and the genitourinary nerve
• Midline coeliotomy may be required in some species to perform reduction

Question 22

Describe a ventral hernia…

Answer 22

A rupture of the abdominal wall through an unnatural opening e.g. a sharp poke hole

Hernia may be present on any part of the abdominal wall

Traumatic or Femoral
- as a result of trauma may need to triage patient

May result from rupture of the prepubic tendon anchored to the pelvis or a free floating pubic fracture

Question 23

What questions could you ask yourself when presented with a potential hernia case?

Answer 23

• What sort of hernia is likely present?
• Is it a true or false hernia?
• Why is it painful now?
• What organs may be the contents of the hernia?
• If it isn’t a hernia, what else could it be?
• What tests could you use to determine if it’s a hernia