Professional Documents
Culture Documents
Abdomin Al Hernias: Reuben Rhubarbs' Tang
Abdomin Al Hernias: Reuben Rhubarbs' Tang
Abdomin Al Hernias: Reuben Rhubarbs' Tang
al hernias
Reuben Rhubarbs
Tang
Introduction
Definition
External/internal
Contents
Intestine
Omentum
Ovary/bladder Images courtesy of McGraw-Hill and Childrens Hospital of
Wisconsin
Introduction (cont.)
Sac
Richters/Maydl/Littres
Aetiology
Weakened abdominal wall
Raised intra-abdominal pressure
Congenital/acquired
Reducible/incarcerated/strangulated
Image courtesy of Surgwiki.com
Types of hernias
Groin hernias
Inguinal
Direct/indirect/Pantaloon
Femoral
Anterior abdominal
Umbilical
Epigastric
Incisional
Spegelian
Pelvic hernias
Obturator
Gluteal/sciatic
Image courtesy of Wikipedia.org
Posterior abdominal wall
Lumbar
Principles of treatment
Watch and wait
Truss
Reduction
Decrease intra-abdominal pressure
Strengthen abdominal wall
Fitzgibbons RJ, Giobbie-Hurder A, Gibbs JO, et al. Watchful Waiting vs Repair of Inguinal Hernia in Minimally Symptomatic Men: A
Randomized Clinical Trial. JAMA. 2006;295(3):285-292. doi:10.1001/jama.295.3.285.
Incidence
Relative occurrence of Sex distribution of abdominal hernias
external abdominal hernias in
adults Male (%) Female (%)
Hernia Percentage Inguinal
96 45
Inguinal 80 hernia
Incisional 10 Femoral
2 39
hernia
Femoral 5
Umbilical
Umbilical >4 1 15
hernia
Epigastric <1 Other 1 1
Other <1
Nyhus, Lloyd Milton, and Henry Nelson Harkins, eds. Hernia. Lippincott, 1964.
Indirect hernia types
Treadwell J, Tipton K, Oyesanmi O, et al. Surgical Options for Inguinal Hernia: Comparative Effectiveness Review. Comparative Effectiveness Review No. 70 (Prepared by the ECRI Institute Evidence-
based Practice Center under Contract No. 290-2007-10063). AHRQ Publication No. 12-EHC091-EF. Rockville, MD: Agency for Healthcare Research and Quality; August 2012. Available at
www.effectivehealthcare.ahrq.gov/inguinal-hernia.cfm.
Femoral hernias
From disruption of
transversalis fascia
overlying femoral canal
More in LOL in NAD
Must be treated
Options
open vs laparoscopic
Lockwood's infra-inguinal
Lotheissen's trans-
inguinal
McEvedy's high approach
Image courtesy of Surgwiki.com
Incisional hernia
Protrusion of hernia through defect at scar post-
abdominal operation
Incidence of 5% at 5 years, 10% at 10 years post
operation
Predisposing factors:
Poor surgical technique
Local wound complications
Impaired wound healing
Raised intraabdominal pressure
Should be repaired when discovered
Epigastric hernia
Protrusion of extraperitoneal
fat through defect in linea
alba
Typically young fit males with
epigastric pain
Surgery to relieve symptoms
Keel repair