Most common hernia among the following is:
Ans: a (Inguinal) Ref: Bailey, 24th ed, p. 1274- Most common hernia in men - Indirect inguinal hernia (right side)- Most common hernia in females - Indirect inguinal hernia- Femoral hernia is more common in females. (F:M -4:1)(You should have a clear idea about this)Inguinal herniaIndirectContents enter the deep inguinal ring and traverse the whole length of the inguinal canal to come out through superficial inguinal ring.Most common of all forms of hernia.More common on right side.Bilateral in 12% of cases.More common in males (~20 times)DirectHere the contents protrude through the posterior wall of the inguinal canal medial to the inferior epigastric vessels, (through Hesselback triangle)Practically never seen in females.Neck is wide so rarely strangulate.Three types of indirect inguinal hernia.Bubonocele - hernia limited in the inguinal canal.Funicular - processes vaginalis closed at its lower end.Complete or vaginal or congenital - here the processes vaginalis is patent throughout.Hernia sac is continuous with the tunica vaginalis of the testis.Management of inguinal hernias1) Treatment of hernial saca) Indirect hernias - Sac is dissected free and opened and herniated contents are reduced. Sac is ligated at the internal inguinal ring,b) Direct hernias - Sac is not opened but simply inverted into peritoneal cavity.2) Inguinal floor reconstructiona) Primary tissue repairPost wall of inguinal canal is strengthened by just approximation of tissues with sutures. No use of any prosthetic material.Commonly performed are:1) Bassini repair2) Halsted repair3) McUay (Cooper ligament) repair4) Shouldice repair.5) Darn repair.b) Anterior tension - free mesh repair - Current practices in hernia management employ a synthetic mesh prosthesis to bridge the defect. Recurrence rate is quite low.Commonly employed techniques are:1) Lichtenstein repair.2) Patch and plug technique.c) Laparoscopic and Preperitoneal repairs1) TAPP (Trans - abdominal pre - peritoneal)2) TEP (Totally extraperitoneal repair)Note - Different types of hernias are mentioned in 2007 Surgery paper. Just go through It.
Inguinal
Femoral
Umbilical
Epigastric
Hernia