Hernias Lecture Notes

Types of Hernias

Inguinal Hernias

• Two Types: Indirect and Direct
• Based on: Position of bowel herniation relative to the inferior epigastric artery
  • Indirect Inguinal Hernia:
    • Herniates lateral to the inferior epigastric artery
    • Commonly caused by increased intraabdominal pressure (e.g., heavy lifting)
  • Direct Inguinal Hernia:
    • Herniates medial to the inferior epigastric artery
    • Also caused by increased intraabdominal pressure (e.g., coughing, sneezing)

Femoral Hernias

• Location: Through the femoral canal
• Risks: High risk of incarceration and strangulation
  • Anatomy: Inguinal ligament, femoral triangle (artery, vein, nerve, lymph nodes)

Ventral Hernias

• Location: Abdominal wall
• Types:
  • Incisional Hernia: Through a surgical incision
  • Umbilical Hernia: Through the umbilical ring (common with obesity and pregnancy)

Complications of Hernias

• Visible Mass: Painful and palpable
• Obstruction: Can lead to small bowel obstructions
  • Symptoms: Cramping, abdominal pain, distension, vomiting, obstipation
  • Closed Loop Obstruction: Dangerous due to compressed bowel causing blood flow issues
  • Risk of Ischemia: May lead to necrosis and perforation

Evaluation of Hernias

• Initial Step: Check if reducible by pushing the mass back into place
  • If reducible: May be treated electively
  • If not reducible: Consider if it’s incarcerated or strangulated
• Diagnostic Tools:
  • Abdominal X-ray: For signs of dilation and air-fluid levels
  • Lactate Levels: Indicate ischemia
  • CT Scan: Best test for identifying complex hernias

Treatment of Hernias

• Uncomplicated Hernias: Reduce and monitor, elective surgery if needed
  • Herniorrhaphy: Surgical closure of defect
  • Hernioplasty: Using synthetic mesh, for large or inguinal hernias
• Incarcerated Hernias: May need manual reduction, refer for urgent surgical evaluation if unsuccessful
• Strangulated Hernias: Requires immediate surgery to prevent perforation and sepsis