J Herniorrhaphy

Inguinal hernias are defects in the transverse abdominal layer; a direct hernia comes through the posterior wall of the inguinal canal, and an indirect hernia comes through the internal inguinal ring. Femoral hernia occurs when the hernia sac is exposed as it exits the preperitoneal space through the femoral canal. Incisional hernias can occur after any abdominal incision, but they are most common after midline incisions. Factors leading to herniation are ischemia, wound infection, trauma, and inadequate suturing. Treatment is with herniorrhaphy.

Predisposing factors for hernia often include increased abdominal pressure secondary to chronic cough, bladder outlet obstruction, constipation, pregnancy, vomiting, and acute or chronic muscular effort. The patient population may range from premature infants to elderly adults, with the possibility of various medical problems.

a) History and physical examination: These are as indicated by the patient’s condition.

(1) Musculoskeletal: Pain is likely in the area of the hernia; evaluate bony landmarks if regional anesthesia is planned.

(2) Hematologic: If regional anesthesia is planned, check the patient’s coagulation status.

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