Identify the Hernia

• 🍒What are the three most common types of hernia to strangulate in order of frequency?

Inguinal Hernias

• 🍒How would you differentiate between indirect and direct inguinal hernias on clinical examination (at least in theory)?

• Indirect (80%)

  • Bowel enters inguinal canal via the deep inguinal ring
  • Occurs as a result of incomplete closure of the processus vaginalis
    • Lateral to the inferior epigastric vessels
    • Paediatric cases are nearly always indirect
  • 🍒What is the management of congenital indirect inguinal hernias in infants?
  • 🍒What are the surgical procedures for repairing an inguinal hernia?
  • 🍒What is involved in the shouldice repair
  • 🍒What is involved in the lichtenstein repair

  

• Direct (20%)

  • Bowel enters through Hesselbach’s triangle
  • 🍒Direct inguinal hernias pass through Hesselbach’s triangle
  • 🍒What are the borders of Hesselbach’s triangle?
  • Occurs commonly in older patients 2° to abdominal wall laxity or significant increase in intra-abdominal pressure
    • Medial to the inferior epigastric vessels

• Risk factors

• Examining a inguinal hernia

• Investigations

• Management

Femoral Hernia

• 🍒What is the most common type of hernia in women?
• 🍒How do you differentiate between an irreducible femoral and an irreducible inguinal hernia on physical exam?
• 🍒Femoral hernias have a relatively higher rate of strangulation
• 🍒What are the three different surgical approaches for elective repair of a femoral hernia?
• 🍒What are three notable differentials for lump in the groin other than inguinal and femoral hernias?