Download presentation
1
Rob Padwick MRCS MMedEd SpR General Surgery
Abdominal Hernias Rob Padwick MRCS MMedEd SpR General Surgery
2
Aims Definition of hernia Overview of types of hernia
Presentation and Management of common types of hernia Quick overview of the rest
3
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
4
Where can hernias occur?
Via natural orifices Via natural ‘weaknesses’ Via iatrogenic orifices Via iatrogenic ‘weaknesses’
5
Types of Abdominal Hernia
Hiatus Inguinal Femoral Umbilical/Paraumbilical Epigastric Incisional Parastomal Perineal Spygelian Lumbar Obturator ‘Internal’ Other diaphragmatic herniae
6
What can hernias do? Nothing Lump Pain Incarcerate; Obstruct;
Something gets stuck Obstruct; Something gets stuck and blocks off Strangulate; Something gets stuck and loses its blood supply
7
Hiatus Hernia VERY COMMON! Via Oesophageal hiatus
Most commonly stomach Occasionally transverse colon or small bowel if very large Rarely cause major problems
8
Hiatus hernia Types; Presentation; Rolling Sliding Asymptomatic
Heartburn Acid reflux Cough Chest symptoms if very large
9
Diagnosis Chest X-Ray Barium Meal CT OGD
10
Hiatus hernia Complications; Treatment; Barrett’s Oesophagus
Obstruction/incarceration/strangulation (rare) Treatment; None PPI Nissen’s Fundoplication
11
M>>F Inguinal Hernia Site; Types; Causes; Inguinal canal
Right/Left groin Types; Direct Indirect Causes; Congenital Raised intra-abdominal pressure
12
The Inguinal Canal
13
The Inguinal Canal Contents; Spermatic Cord; Ilioinguinal nerve
Vas deferens Testicular artery and veins Pampiniform plexus Artery to the Vas Ilioinguinal nerve Genital branch of Genitofemoral nerve Iliohypogastric nerve
14
Inguinal Hernia Presentation; Lump Pain Bowel obstruction
Scrotal symptoms
15
Indirect Inguinal Hernia
Take the ‘Indirect’ route; Exit abdomen via deep ring Through whole inguinal canal Exit superficial ring May enter scrotum
16
Direct Inguinal Hernia
Take the ‘Direct’ route; Exit abdomen via Hesselbach’s Triangle Exit superficial ring Do not enter scrotum
17
Inguinal Hernia Complications; Pain Incarceration Obstruction
Srangulation
18
Inguinal Hernia Treatment; Conservative (e.g. Truss) Surgery; Open
Laparoscopic
19
Inguinal Hernia Complications of Surgery; Bleeding Infection Pain
Bruising Parasthesia Recurrence Testicular problems; Small ball Blue ball Black ball No ball
20
Femoral Hernia Site; Into the femoral canal Via the femoral ring
21
F>M Femoral Hernia Presentation; Treatment; Lump Pain
Symptoms of obstruction Treatment; Surgery F>M
22
Umbilical/Paraumbilical Hernias
Site; Midline Into umbilical skin Umbilical; Relatively rare Most commonly in children Congenital defect Paraumbilical Very common!
23
Umbilical/Paraumbilical Hernias
Presentation; Usually asymptomatic Lump Pain Treatment; Vast majority need none Repair if troublesome – most commonly contain omentum only
24
Epigastric Hernia Site; NB Divarication of rectus Midline
Above paraumbilical herniae Rest see above NB Divarication of rectus
25
Incisional Hernia Site; Treatment; Via any surgical incision
Depends on whether causing problems Leave alone Surgery
26
Parastomal Hernia Site; Treatment; Around stoma Conservative Surgery;
Repair Resiting stoma
27
Perineal Site; Presentation; Treatment; Via perineal orifices; Pain
Vagina Rectum Presentation; Pain Feeling of lump descending Urinary symptoms Bowel Symptoms Treatment; Conservative Surgery
28
Other Abdominal Hernias
Spygelian; Through linea semilunaris Lumbar; Petit (inferior) Grynfeltt (superior) Internal Obturator; Through obturator canal Other diaphragmatic herniae; Bochdalek Morgagni
29
Questions?
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.