Hernia Surgery Overview

Study Notes

Direct Hernia: Occurs within Hesselbach’s triangle; associated with acquired weakness in the abdominal wall; does not affect the scrotum.
Indirect Hernia: Most common, protrudes through the deep inguinal ring; occurs laterally to epigastric vessels; can affect the spermatic cord in males.
Reducible Hernia: Can be manually reduced; not trapped.
Non-reducible Hernia: Cannot be returned to abdominal cavity.
Incarcerated Hernia: Trapped in the extra-abdominal sac, may lead to obstruction.
Strangulated Hernia: Blood supply compromised; requires emergency intervention.
Incisional Hernia: Occurs at a previous surgical site.
Umbilical Hernia: Fascial defect under the umbilicus; common in children and obese patients.

Defined as a sac containing organ or tissue protruding through a weakness in the abdominal wall.
Composed of covering tissue and a peritoneal sac.
May be congenital or acquired due to musculofascial defects.
Most occur in the abdominal wall; common sites include inguinal canal, femoral ring, and umbilicus.

Hernia repair is known as “Herniorrhaphy.”
Signs of hernias include bulging at the site and symptoms of intestinal obstruction.
Surgical options vary: open surgery, laparoscopic, and robotic techniques.
Mesh use is common for strength and integrity restoration.

Native Tissue Repair: Local tissues utilized; involves identifying key nerves (iliohypogastric and ilioinguinal).
Mesh Overlay (Lichtenstein Repair): Uses a single sheet of mesh for support; sutured to the internal oblique aponeurosis.
Mesh Plug Repair: Tension-free approach with a cone-shaped plug; less tissue dissection and fewer sutures needed.

Inguinal Hernia: Transversalis fascia is crucial; repair goal is to strengthen posterior floor.
Femoral Hernia: Most common in females; occurs in the femoral canal; high risk of strangulation.
Abdominal Hernias: Include umbilical and epigastric, typically arising from muscle weakness; umbilical hernia is particularly susceptible to incarceration.

Minimally invasive: smaller incisions, reduced pain, quicker recovery, and fewer recurrence rates.

Assess type and location of hernia; ensure correct surgical site marking.
Position patients supine for surgery; anesthesia options include general or spinal, depending on patient health.
Instruments used include atraumatic techniques and specific sutures (Surgipro/Prolene) for mesh repairs.

50% of hernias are indirect (predominantly in males); 25% direct; 10% incisional; 3% femoral (most common in females).

Incarcerated hernia symptoms: vomiting, intestinal obstruction, abdominal distention.
Strangulated hernia is an emergency; prompt surgical intervention is critical.