8/10/2019 3. Notes Hernias

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Copyright The Surgery 101 team (www. surgery101.org) 2012

3. Hernias

In this episode, Dr. Parveen Booradiscusses hernias.

Topics covered include: what a hernia is and the different types of hernias anatomy and where hernias may be found risk factors complications options for treatment

Introduction

hernias of abdominal wall one of most common reasons for seeing ageneral surgeon

can present at any age from pediatric to geriatric

can present as a benign incidental finding or dramatic, life-threateningcondition

Definition

abdominal wall hernia is protrusion of intra-abdominal contentsthrough a defect in the fascia of the abdominal wall

! can be congenital or acquired! risk factors for development are male, older age, obesity

and any cause of increased intra-abdominal pressure most common hernias are groin hernias, with inguinal and femoral

hernias also included in this group other major group of are ventral hernias, which include incisional,

umbilical and epigastric hernias

8/10/2019 3. Notes Hernias

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Copyright The Surgery 101 team (www. surgery101.org) 2012

Categories of Hernias

reducible hernia! contents can be pushed back inside the abdomen! repair is either deferred or done electively

incarcerated hernia! cannot be reduced! may become progressively engorged! is indication for emergency surgery if contains small

bowel! are otherwise repaired electively

strangulated hernia! when pressure in hernia sac compromises inflow of

arterial blood and herniated tissues begin to die! is a surgical emergency! differentiate from incarcerated hernia by presence of

extreme pain, tenderness and erythema of overlying skin

Summary

A hernia is the abnormal protrusion of an intra-abdominal structure through theabdominal wall via a defect in the fascia.

Abdominal wall hernias include groin hernias and ventral hernias. Groin herniasinclude inguinal hernias both direct and indirect - and femoral hernias. Ventralhernias include incisional, umbilical and epigastric hernias.

Hernias may be reducible, meaning that they can be pushed back into theabdomen; irreducible, meaning that they cannot be pushed back into theabdomen; or strangulated, meaning that the blood supply of the hernia contentshas been compromised, eventually leading to necrosis.

Emergent hernia repair is indicated in strangulated hernias or hernias causingbowel obstruction.

Most hernias are repaired in an elective fashion when they become symptomatic. Open and laparoscopic approaches exist for hernia repair, with most repairs

involving the use of synthetic mesh.