Fundamentals

Pathophysiology

  • Hernias consist of weakness and discontinuity in a cavity wall, usually of the muscle or fascia
  • This allows a body organ (e.g. bowel) to pass through that cavity wall where it normally would be contained

 

General Presentation

  • A soft lump
  • They may be able to reduce (put back) the lump (hernia)
  • The lump may protrude on coughing (raising intraabdominal pressure) or standing (pulled out by gravity)
  • Aching or dragging sensation

 

Complications (the big three)

  • Incarceration
    • An incarcerated hernia is when the hernia cannot be reduced back
    • The bowel will be trapped in the herniated position
    • It can lead to obstruction and strangulation
  • Obstruction
    • This is where a hernia causes a blockage in the passage of faeces through the bowel (see notes on general surgery for obstruction)
    • Will present with signs of obstruction (vomiting, absolute constipation, abdominal pain)
  • Strangulation
    • This is where a hernia is non-reducible (it is trapped with the bowel protruding) and the base of the hernia becomes so tight it cuts off the blood supply
    • This will present with significant pain, tenderness at the hernia site
    • This is a surgical emergency, and the bowel will die quickly (within hours) if not corrected with surgery
    • There will be a mechanical obstruction

 

Management Options

  • Conservative
    • Leave the hernia alone
    • Appropriate in patients with broad based hernias (low risk of complications) who are not fit for surgery
  • Tension repair
    • The muscles and tissue either side of defect are sutured back together
    • The hernia is held closed (to heal there) by sutures applying tension
    • Can cause pain
    • Has high recurrence rates
  • Tension Free Repair
    • A mesh is placed over the defect (covering the hernia)
    • The mesh is sutured to the muscles and tissues either side of the defect
    • The mesh covers the defect and holds the muscles and tissues closed
    • Lower recurrence rates
WordPress Theme built by Shufflehound. Copyright 2016-2021 - Zero to Finals - All Rights Reserved