Hernia Types and Treatment Overview

Hernia Types and Treatment

• Hernias are protrusions of a bodily organ through an abnormal opening in the surrounding wall
• Common hernia types include inguinal, umbilical, incisional, femoral, and epigastric
• Children typically receive a hernia repair called herniotomy, not herniorrhaphy
• Adults commonly undergo hernia repair surgery called herniorrhaphy, that often includes methods like Lichtenstein repair, Bassini, and Shouldice
• Laparoscopic hernia repairs (TEP & TAPP) are used for bilateral or recurring hernias in adults

Hernia Causes

• Weakness in the abdominal wall
• Structures leaving or entering the abdomen causing weakness
• Developmental failures
• Collagen issues
• Trauma
• Aging
• Pregnancy
• Neurological issues
• Increased intra-abdominal pressure (contributing factor)

Hernia Types (Clinical)

• Occult: Not clinically detected
• Reducible: Contents return to the abdomen
• Irreducible: Contents cannot be returned, but no other complications
• Obstructed: Bowel within the hernia has blood supply yet obstructed
• Strangulated: Blood supply to the hernia contents is compromised
• Infarcted: Contents of hernia become gangrenous (dead tissue)

Hernia Symptoms and Signs

• Painless lump on abdominal wall
• Aching or heavy feeling
• Signs include presence at weak anatomical spot, disappearing when lying down or compressed, potential expansile cough impulse
• Symptoms include a lump that sometimes appears and disappears, often no pain, ability to return to the abdomen when pressed, and not returning when elevated
• In strangulated cases, pain is sudden, colicky, and located around the umbilicus, with nausea, vomiting, constipation, and potential increased hernia size

Hernia Types and Anatomical Locations

• Inguinal Hernia
• Direct: Through the posterior wall of the inguinal canal often seen in elderly patients.
• Indirect: Through the deep inguinal ring and usually present in children and young adults, descending into the scrotum
• Inguinal Canal Boundaries
• Anterior: External oblique aponeurosis
• Posterior: Transversalis fascia
• Superior: Conjoined muscles (internal oblique and transversus)
• Inferior: Inguinal ligament
• Femoral Hernia: Passing through the femoral canal, found below the inguinal ligament
• Umbilical Hernia: Protrusion through the abdominal wall near the umbilicus (belly button)
• Epigastric Hernia: Occurring in the epigastric region (mid-upper abdomen)

Hernia - Treatment Options

• Bassini Repair: Conjoint tendon repair tied together with mattress sutures
• Shouldice Repair: Internal oblique and transversus abdominis muscles positioned over the ring
• Lichtenstein Repair: Utilizing a polypropylene mesh and wrapped around spermatic cord
• Other repair techniques include TEP and TAPP via laparoscopy

Hernia Complications

• Early: Injury to structures, pain, bleeding, urinary retention
• Medium: Seroma, wound infection
• Late: Chronic pain, testicular atrophy, recurrence
• Hernia Types: Indirect and direct inguinal hernias are possible to treat. Conservative methods exist but surgery is the ideal treatment
• Specific Issues with Treatments: Some methods have limitations like risk of infection, chronic pain, or possible failure to cure the pain.

Other Hernia Information

• Sports hernia is a specific type in young male athletes with groin, scrotum, and upper thigh pain, often an orthopedic injury, not a hernia
• A 'truss' is a device used to support or hold a reducible hernia if surgery isn't possible or desired.
• A strangulated hernia has impaired blood supply and can lead to gangrene