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Abdominal Hernias

Abdominal Hernias. Rob Padwick MRCS MMedEd SpR General Surgery. Aims. Definition of hernia Overview of types of hernia Presentation and Management of common types of hernia Quick overview of the rest. What is the definition of a hernia?.

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Abdominal Hernias

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  1. Abdominal Hernias Rob Padwick MRCS MMedEd SpR General Surgery

  2. Aims • Definition of hernia • Overview of types of hernia • Presentation and Management of common types of hernia • Quick overview of the rest

  3. What is the definition of a hernia? An abnormal protrusion of a viscus from the body cavity of its origin into another cavity of the body

  4. Where can hernias occur? • Via natural orifices • Via natural ‘weaknesses’ • Via iatrogenic orifices • Via iatrogenic ‘weaknesses’

  5. Types of Abdominal Hernia • Hiatus • Inguinal • Femoral • Umbilical/Paraumbilical • Epigastric • Incisional • Parastomal • Perineal • Spygelian • Lumbar • Obturator • ‘Internal’ • Other diaphragmatic herniae

  6. What can hernias do? • Nothing • Lump • Pain • Incarcerate; • Something gets stuck • Obstruct; • Something gets stuck and blocks off • Strangulate; • Something gets stuck and loses its blood supply

  7. Hiatus Hernia • VERY COMMON! • Via Oesophageal hiatus • Most commonly stomach • Occasionally transverse colon or small bowel if very large • Rarely cause major problems

  8. Hiatus hernia • Types; • Rolling • Sliding • Presentation; • Asymptomatic • Heartburn • Acid reflux • Cough • Chest symptoms if very large

  9. Diagnosis • Chest X-Ray • Barium Meal • CT • OGD

  10. Hiatus hernia • Complications; • Barrett’s Oesophagus • Obstruction/incarceration/strangulation (rare) • Treatment; • None • PPI • Nissen’s Fundoplication

  11. Inguinal Hernia M>>F • Site; • Inguinal canal • Right/Left groin • Types; • Direct • Indirect • Causes; • Congenital • Raised intra-abdominal pressure

  12. The Inguinal Canal

  13. The Inguinal Canal • Contents; • Spermatic Cord; • Vas deferens • Testicular artery and veins • Pampiniform plexus • Artery to the Vas • Ilioinguinal nerve • Genital branch of Genitofemoral nerve • Iliohypogastric nerve

  14. Inguinal Hernia • Presentation; • Lump • Pain • Bowel obstruction • Scrotal symptoms

  15. Indirect Inguinal Hernia • Take the ‘Indirect’ route; • Exit abdomen via deep ring • Through whole inguinal canal • Exit superficial ring • May enter scrotum

  16. Direct Inguinal Hernia • Take the ‘Direct’ route; • Exit abdomen via Hesselbach’s Triangle • Exit superficial ring • Do not enter scrotum

  17. Inguinal Hernia • Complications; • Pain • Incarceration • Obstruction • Srangulation

  18. Inguinal Hernia • Treatment; • Conservative (e.g. Truss) • Surgery; • Open • Laparoscopic

  19. Inguinal Hernia • Complications of Surgery; • Bleeding • Infection • Pain • Bruising • Parasthesia • Recurrence • Testicular problems; • Small ball • Blue ball • Black ball • No ball

  20. Femoral Hernia • Site; • Into the femoral canal • Via the femoral ring

  21. Femoral Hernia • Presentation; • Lump • Pain • Symptoms of obstruction • Treatment; • Surgery F>M

  22. Umbilical/Paraumbilical Hernias • Site; • Midline • Into umbilical skin • Umbilical; • Relatively rare • Most commonly in children • Congenital defect • Paraumbilical • Very common!

  23. Umbilical/Paraumbilical Hernias • Presentation; • Usually asymptomatic • Lump • Pain • Treatment; • Vast majority need none • Repair if troublesome – most commonly contain omentum only

  24. Epigastric Hernia • Site; • Midline • Above paraumbilical herniae • Rest see above • NB Divarication of rectus

  25. Incisional Hernia • Site; • Via any surgical incision • Treatment; • Depends on whether causing problems • Leave alone • Surgery

  26. Parastomal Hernia • Site; • Around stoma • Treatment; • Conservative • Surgery; • Repair • Resiting stoma

  27. Perineal • Site; • Via perineal orifices; • Vagina • Rectum • Presentation; • Pain • Feeling of lump descending • Urinary symptoms • Bowel Symptoms • Treatment; • Conservative • Surgery

  28. Other Abdominal Hernias • Spygelian; • Through lineasemilunaris • Lumbar; • Petit (inferior) • Grynfeltt (superior) • Internal • Obturator; • Through obturator canal • Other diaphragmatic herniae; • Bochdalek • Morgagni

  29. Questions?

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