Dónal Murphy General Surgical Registrar AustinNorthern AGSU What is a Hernia Types of hernia Anatomy of Inguinal Canal Think of it like a tube DirectIndirect hernias Inguinal Hesselbachs ID: 1009437
Download Presentation The PPT/PDF document "Inguinal Hernias: Diagnosis and manageme..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1. Inguinal Hernias:Diagnosis and managementDónal MurphyGeneral Surgical Registrar – Austin/Northern AGSU
2. What is a Hernia?
3. Types of hernia
4. Anatomy of Inguinal Canal
5. Think of it like a tube
6. Direct/Indirect hernias
7. Inguinal (Hesselbach’s) Triangle
8. Good animated video on Direct/Indirect Inguinal Herniashttps://www.youtube.com/watch?v=nmD6nZdJtuU
9. Aetiology of Inguinal Hernias
10. Contents of a Hernia?
11. Signs and SymptomsAssymptomatic BulgeIncreases with standing/ActivityGone when they wake in the morningPainObstructive symptomsNausea and VomitingBowels not opening/Not passing flatusSkin Changes
12. Incarcerated/Strangulated vs Reducible
13.
14. Red FlagsIrreducible Hernia presenting with Narrow neckIncreasing pain over siteSkin compromise ObstructionUnwell patient – Tachycardic, rising lactate, no other obvious cause
15. ExamLocation of swelling?Previous surgery?Painful?Possible contents?When to reduce?When to investigate and with what?Question of contentsObese patient and difficult examCT/US?Aid to surgical planning and timing of intervention
16.
17. Femoral Hernia
18. TreatmentTreat precipitating factorsUse of bands or a Truss for symptomatic management in an uncomplicated herniaSurgeryWhen not to use Mesh?
19. Open Surgery – Hernioplastyhttps://www.youtube.com/watch?v=GciYSjdLR-w
20. Laparoscopic Surgery – TEP or TAP?Extra Peritoneal or Abdominal Same Anatomy, different view
21. TEP view of Direct/IndirectTEP Hernia Repair
22. How do they compare? Laparoscopic OpenLonger surgery (average 15 mins)Shorter surgeryExpensive consumablesCheapLess pain on Day 1 and at 2 weeksLonger to return normal activities (1 day)More common recurrence in Primary HerniasSimilar recurrence in Recurrent HerniasHigher rates of serious complications (bladder/bowel/vessel injury)Stepper learning curve https://www.nejm.org/doi/full/10.1056/NEJMoa040093https://www.cochrane.org/CD001785/COLOCA_laparoscopic-techniques-versus-open-techniques-for-repair-of-a-hernia-in-the-groinhttps://www.sages.org/meetings/annual-meeting/abstracts-archive/apples-to-apples-a-comparison-of-laparoscopic-versus-open-preperitoneal-inguinal-hernia-repair/
23. ComplicationsAcuteChronicPainPainBleeding/HaematomaSeromaUrinary retentionRecurrence Infected woundInfected Mesh
24. Thank you any questions?