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Christine Hawks
July 31, 2014
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Inguinal Hernias
Christine Hawks
July 31, 2014
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Transcript
Inguinal Hernias Christine Hawks
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
Anatomy •Direct hernia: Hesselbach’s triangle •Indirect hernia: Inguinal canal •Spermatic
cord •Round ligament •Ilioinguinal nerve
None
None
Diagnosis • History and physical • Discomfort • Palpable bulge
easiest to demonstrate with patient standing • Cough or Valsalva
Incarceration and Strangulation • Incarcerated hernia • Hernial sac cannot
be reduced • Can contain bowel, bladder, omentum, ovary • Painful • Can lead to strangulation
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
Repair • Incarcerated or strangulated hernia • Urgent repair •
Asymptomatic, non-incarcerated hernia • Elective repair
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
Lichtenstein Repair
Plug and Patch Repair
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
Complications • Chronic pain (up to 30%) • Recurrence (less
than 1%) • Ischemic orchitis (rare)
The End “Living With a Hernia” by Weird Al Yankovic:
http://youtu.be/X8Ow1nlafOg