Rob Padwick MRCS MMedEd
SpR General Surgery
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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?
An abnormal protrusion
of a viscus from the body
cavity of its origin into
another cavity of the
body
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Via natural orifices
Via natural ‘weaknesses’
Via iatrogenic orifices
Via iatrogenic ‘weaknesses’
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Hiatus
Inguinal
Femoral
Umbilical/Paraumbilical
Epigastric
Incisional
Parastomal
Perineal
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Spygelian
Lumbar
Obturator
‘Internal’
Other diaphragmatic
herniae
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Nothing
Lump
Pain
Incarcerate;
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Obstruct;
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Something gets stuck
Something gets stuck and blocks off
Strangulate;
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Something gets stuck and loses its blood supply
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VERY COMMON!
Via Oesophageal hiatus
Most commonly stomach
Occasionally transverse colon or small bowel if
very large
Rarely cause major problems
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Types;
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Rolling
Sliding
Presentation;
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Asymptomatic
Heartburn
Acid reflux
Cough
Chest symptoms if very large
Diagnosis
•Chest X-Ray
•Barium Meal
•CT
•OGD
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Complications;
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Barrett’s Oesophagus
Obstruction/incarceration/strangulation (rare)
Treatment;
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None
PPI
Nissen’s Fundoplication
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Site;
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Types;
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Inguinal canal
Right/Left groin
Direct
Indirect
Causes;
Congenital
– Raised intra-abdominal
pressure
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M>>F
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Contents;
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Spermatic Cord;
 Vas deferens
 Testicular artery and veins
 Pampiniform plexus
 Artery to the Vas
Ilioinguinal nerve
 Genital branch of Genitofemoral nerve
 Iliohypogastric nerve
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Presentation;
Lump
 Pain
 Bowel obstruction
 Scrotal symptoms
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Take the ‘Indirect’ route;
Exit abdomen via deep ring
 Through whole inguinal canal
 Exit superficial ring
 May enter scrotum
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Take the ‘Direct’ route;
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Exit abdomen via Hesselbach’s Triangle
Exit superficial ring
Do not enter scrotum
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Complications;
Pain
 Incarceration
 Obstruction
 Srangulation
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Treatment;
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Conservative (e.g. Truss)
Surgery;
 Open
 Laparoscopic
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Complications of Surgery;
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Bleeding
Infection
Pain
Bruising
Parasthesia
Recurrence
Testicular problems;
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Small ball
Blue ball
Black ball
No ball
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Site;
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Into the femoral canal
Via the femoral ring
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Presentation;
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Lump
Pain
Symptoms of obstruction
Treatment;
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Surgery
F>M
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Site;
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Umbilical;
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Midline
Into umbilical skin
Relatively rare
Most commonly in children
Congenital defect
Paraumbilical
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Very common!
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Presentation;
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Usually asymptomatic
Lump
Pain
Treatment;
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Vast majority need none
Repair if troublesome – most commonly contain
omentum only
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Site;
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Midline
Above paraumbilical herniae
Rest see above
NB Divarication of rectus
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Site;
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Via any surgical incision
Treatment;
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Depends on whether causing problems
Leave alone
Surgery
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Site;
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Around stoma
Treatment;
Conservative
 Surgery;
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 Repair
 Resiting stoma
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Site;
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Via perineal orifices;
• Vagina
• Rectum
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Presentation;
Pain
– Feeling of lump descending
– Urinary symptoms
– Bowel Symptoms
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Treatment;
Conservative
– Surgery
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Spygelian;
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Through linea semilunaris
Lumbar;
Petit (inferior)
– Grynfeltt (superior)
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Internal
Obturator;
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Through obturator canal
Other diaphragmatic herniae;
Bochdalek
– Morgagni
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