Auer Ch 39 Abdominal Hernias

Front 1

True (or indirect) hernia:

Back 1

protrusion though a normal aperture in the abdomen and contains a complete peritoneal sac

Front 2

False (or direct) hernia:

Back 2

protrusion through an aperture that is not normal and do not contain complete peritoneal sac

Front 3

Parietal (or Richter or Littre) hernia:

Back 3

involves only a portion of the intestinal wall

Front 4

When does risk of strangulation increase?

Back 4

contraction of the hernial ring scar, inflammation of the hernial sac, faster peristaltic motion of intestine into the sac than out of the sac, and increased secretion or pooling of peritoneal fluid in the sac causing distention of the sac

Front 5

How can umbilical hernias form?

Back 5

foaling trauma, excessive straining, and umbilical cord infection

Front 6

How are umbilical hernias managed?

Back 6

Hernias less than 5 cm usually spontaneously regress and should be treated with daily digital reduction. Hernias that are greater than 10 cm or do not regress after 4 months should be surgically repaired

Front 7

What is the disadvantage of the hernia clamp?

Back 7

risk of incarcerating bowel and the formation of enterocutaneous fistula

Front 8

Types of umbilical hernia surgical repair:

Back 8

closed, by leaving the hernia sac intact and inverting it prior to linea closure or repair can be open, removing the hernia sac prior to linea closure

Front 9

How can risk of ventral midline hernias be reduced?

Back 9

closing initially with proper suture placement, suture selection, soft tissue handling, and aseptic technique

Front 10

Optimal bite size for linea closure:

Back 10

15mm from incision edge

Front 11

Strongest linea closure suture:

Back 11

6 polyglactin 910 and 5 polyglycolic acid

Front 12

What suture is recommended for hernia repair in adult horses?

Back 12

7 PDS and 6 polyglactin 910

Front 13

Where does linea suture fail?

Back 13

93% of suture fails at the knot and suture loops fail before fascial disruption

Front 14

Where do most incisional hernias occur?

Back 14

Because the linea is thinner cranially, more incisional hernias occur in the cranial aspect of the incision

Front 15

Classes of incisional hernias:

Back 15

acute total dehiscence or chronic incisional hernias

Front 16

When does acute total dehiscence usually occur?

Back 16

first 4-7 days post-operatively

Front 17

How is acute total dehiscence repaired?

Back 17

performed with monofilament stainless steel wire with rubber stent tubing in a through and through interrupted vertical mattress pattern. The wire suture is placed 5cm (2 inches) and 2.5 cm (1 inch) from the incision edge

Front 18

What is the benefit of rubber stents in repairing acute total dehiscence of a ventral midline incision?

Back 18

prevents wire cutting through the skin

Front 19

What post-operative care is recommended for acute total dehiscence herniorrhapy?

Back 19

Bandaging is changed daily for a month. At 14 days from the repair, alternate wire sutures are removed, with complete removal by day 21

Front 20

How are chronic incisional hernias managed?

Back 20

Conservatively, or arge defects should be reconstructed

Front 21

Conservative management for chronic incision hernias:

Back 21

Infection should be treated with antimicrobials, drainage, flushing only if good drainage exisits, and bandaging for a prolonged period of time

Front 22

When is chronic incision herniorrhapy performed?

Back 22

at least 8-10 weeks after complete resolution of infection

Front 23

Mesh implant options for chronic incisional herniorrhaphy:

Back 23

knit polypropylene mesh (Marlex), coated polyester (Mersilene), and polyglactin 910

Front 24

Advantages of polyglactin 910 mesh implant:

Back 24

absorbable and may not need to be removed if it becomes infected

Front 25

Options for chronic incisional mesh hernioplasty:

Back 25

subperitoneal mesh placement with fascial overlay, subperitoneal mesh placement with hernial ring apposition, subcutaneous placement with hernial ring apposition, and laparoscopic intraperitoneal mesh overlay

Front 26

Describe subperitoneal mesh placement with fascial overlay:

Back 26

incision follows the contour of the hernia, the skin & SQ tissue are reflected, and the fascia is dissected from the peritoneum (if possible). The mesh is placed retroperitoneal and subfascially. Sutures are preplaced and when tightened, the mesh lays flat. The hernia flap is trimmed and the free edge is sutured to the edge of the hernia ring. The linea is not apposed

Front 27

Describe subperitoneal mesh placement with hernia ring apposition:

Back 27

linear skin incision is made and the skin and SQ tissues are reflected. The fascia is dissected from the peritoneum (if possible.) The mesh is placed between the body wall and the peritoneum and sutured to one side. Sutures are preplaced in the other side of the mesh, the linea is apposed, the mesh sutures are tightened, and the linea is closed.

Front 28

Describe subcutaneous placement of mesh:

Back 28

linear incision is made and the skin & SQ are reflected. The hernia sac is inverted and the ring is closed with tension relieving suture. Mesh is placed over the ring closure and sutured to the abdominal tunic

Front 29

Describe laparoscopic mesh hernioplasty approach:

Back 29

mesh is positioned subperitoneally, overlaying the inner surface of the internal rectus sheath. Mesh sutures are placed transfascially, securing the mesh to the peritoneum, and tied extrafascially

Front 30

Complications of chronic incisional hernia repair:

Back 30

greater in horses weighing more than 450 kg, incisional drainage and tearing of the internal abdominal oblique muscle

Front 31

Predisposing factors for prepublic tendon rupture:

Back 31

hydrop allantois, hydrops amnion, trauma, twins, fetal giants, draft breeds, and age

Front 32

How do congenital diaphragmatic hernias develop?

Back 32

failure fusion of 1 of 4 embryonic components of the diaphragm

Front 33

Hoe do acquired diaphragmatic hernias develop?

Back 33

Trauma

Front 34

Types of diaphragmatic hernias:

Back 34

peritoneal-pericardial or peritoneal-pleural

Front 35

How are diaphragmatic hernias repaired?

Back 35

Small defects are repaired with primary apposition, with sutures placed in the scared hernial ring. Large defects can be reconstructed with mesh placed on the abdominal side of the defect

Front 36

What approach can be taken for very large traumatic diaphragmatic hernias?

Back 36

thoracotomy may be required, in addition to VMC, for access. Alternatively, thoroscopy can be used in conjunction with thoracotomy and rib resection to repair diaphragmatic hernias and mesh placement

Front 37

Back 37