Abnormal protrusion of any intra-abdominal structure outside of abdomen, covered in peritoneal lining
Richter’s hernia: contains only part of circumference of bowel; reduction may occur; may be ischaemic
despite reduction  perforation
Adhesion, obstruction, strangulation (most likely in indirect inguinal)
Epidemiology: lifetime incidence 25% males, 5% women; 3%/month
risk of strangulation in adult; most common in prems; strangulation
more common in infants  OT should be ASAP; most common hernia
(including in women)
Examination: cough impulse above pubic tubercle; Above and medial
to syphysis pubis
Indirect: 2/3; persistent tunica vaginalis; through internal inguinal ring
 scrotum; immediately lateral to mid-point on inguinal ligament;
Lateral to inferior epigastric artery; Usually reducible; frequent
strangulation
Direct: 1/3; progressive weakening of transversalis fascia and muscular wall, does not go to scrotum;
Medial to inferior epigastric artery; Diffuse lump, less symptoms, less
complications, older age group
Epidemiology: more common in older females, inguinal hernia still
most common hernia in women; M:F 5:1; 5% mortality; 20%/month
risk of strangulation
Pathophysiology: through femoral canal; ant and medial to femoral
artery; medial to inferior epigastric artery; prone to ischaemia;
symptoms early; complications common
Examination: cough impulse below and lateral pubic tubercle
Management: needs urgent OT
Umbilical: Usually resolve spontaneously in children (refer if still present at 4yrs); usually progress in
adults, prone to complications, need OT
Incisional: Incidence 15% following extensive complicated OT; often associated with wound infection;
complications uncommon; risk factors = obesity, age, co-morbidities
Epigastric: Common; rarely symptomatic; multiple in 20%; 80% just off midline; small nub of fat through
linea alba usually midway between umbilicus and xiphisternum
Lumbar: Through posterolateral abdominal wall; 80% acquired, 20% congenital; risk factors = XS weight
loss, pulmonary disease, old, strenous physical labour, OT, trauma; superior triangle is most common
site for spontaneous herniation; difficult to diagnose; present with abdominal / flank pain + bowel
obstruction; needs OT
Obturatory: Uncommon; through obturator foramen; in old females; usually presents as bowel
obstruction; perforation in 50%; mortality 20%
Spigelian: lateral to rectus abdominus; in old men
Acute: OT (urgent if irreducible / obstruction); only attempt reduction if present <4hrs, no signs of bowel
obstruction and normals obs (ie. No signs of strangulation); IV fluids, antibiotics
Laparoscopic repair: pros:  post-op pain,  time off work
Cons: longer;  complication rate (visceral injury),  hospital cost; operator
dependent; difficult to learn
Long term: weight loss; avoid straining; refer surgical outpatients if reducible