Inguinal Hernias

Transcript

1. Inguinal Hernias Christine Hawks
2. Epidemiology • Most common type of hernia in both males and females • Risk factors: • Male • Older age • Chronic cough, constipation, heavy lifting (increased intra-abdominal pressure) • Smoking
3. Anatomy •Direct hernia: Hesselbach’s triangle •Indirect hernia: Inguinal canal •Spermatic cord •Round ligament •Ilioinguinal nerve
6. Diagnosis • History and physical • Discomfort • Palpable bulge easiest to demonstrate with patient standing • Cough or Valsalva
7. Incarceration and Strangulation • Incarcerated hernia • Hernial sac cannot be reduced • Can contain bowel, bladder, omentum, ovary • Painful • Can lead to strangulation
8. Incarceration and Strangulation • Strangulated hernia • Ischemia and necrosis of hernial sac contents due to compromised blood flow • Bowel obstruction • 10% mortality • Do not attempt to reduce
9. Repair • Incarcerated or strangulated hernia • Urgent repair • Asymptomatic, non-incarcerated hernia • Elective repair
10. Lichtenstein Repair • Hernioplasty: herniotomy (removal of the hernial sac) plus reinforcement of the posterior wall with mesh • Hernial sac may be inverted, diverted, resected, or ligated
11. Lichtenstein Repair
12. Plug and Patch Repair
13. Post-Op Care • Patient should ambulate as soon as possible • May be discharged on the same day depending on type of anesthesia used • Avoid heavy lifting for 6 weeks
14. Complications • Chronic pain (up to 30%) • Recurrence (less than 1%) • Ischemic orchitis (rare)
15. The End “Living With a Hernia” by Weird Al Yankovic: http://youtu.be/X8Ow1nlafOg