Abdominal Wall Hernias
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Introduction
A hernia is an organ protruding or bulging from its normal anatomical boundaries.
Incarcerated hernias are irreducible, while strangulated hernias are ischemic and potentially necrotic.
The Case of...
Types of Hernia
Groin hernias can be
- direct (medial to inferior epigastric vessels)
- indirect (laterial to inferior epigastric vessels, or Hesselbach's triangle)
- femoral (below the ileoinguinal ligament) least common
Umbilical hernias
Umbilical hernias are congenital. They occur via the umbilical fibromuscular ring. They usually spontaneously resolve and are rare after age 5.
Incisional hernia
Incisional hernias occur in up to 10% of abdominal operations.
- infection
- smoking
- obesity
- inherent collagen/elastin disorders (Ehlers-Dnlos, Marfan)
- poor technique
Pathophysiology
Inguinal hernias result from a defect in processus vaginalis
Signs and Symptoms
- history
- physical exam
History
Obturator hernias present as pain and paresthesias in the inner thigh as the obturator nerve is compressed.
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
IgG can be elevated
Type I:
Type II:
Diagnostic Imaging
Differential Diagnosis
Treatments
It is still not known if all groin hernias need to be repaired, though surgical correction is the standard of care.
The patch-and-plug repair is the more common
Laproscopic repair (recurrent repair, bilateral, athletes, morbid obesity
Umbilical Hernias
Umbilical hernias should be left alone in children under two years old and fixed in children above two in which they are enlarging or bothersome.
A sutured (Mayo) repair is simple but with high recurrence. An open mesh repair carries increased risk of infection, while laproscopic repair (if the skill exists) has a higher success rate and lower infectious risk.
Incisional Hernias
Incisional hernia repair has a high reccurence rate with open suture repair and high infection rate with open mesh repair.
Lumbar hernias should be fixed rarely due to their low risk of morbidity and high risk of serious complications.
Consequences and Course
Resources and References
Topic Development
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