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?