Rationale

A hernia is an abnormal protrusion of part of a viscus through its containing wall. Hernias, in particular inguinal hernias, are very common, and thus, herniorrhaphy is a common surgical intervention.

Causal Conditions

(list not exhaustive)

1. Congenital hernia

   1. Infantile inguinal hernia

   2. Umbilical

2. Acquired hernia

   1. Inguinal hernia

      • Indirect

      • Direct

   2. Femoral hernia

   3. Umbilical hernia

   4. Ventral (incisional) hernia

Key Objectives

Particular attention should be paid to the physical examination and identification of the type of hernia. Non-reducible (incarcerated) hernias are at increased risk for strangulation and require emergent, rather than elective, repair.

Enabling Objectives

Given a patient with a hernia, the candidate will

1. list and interpret critical clinical findings, including

   1. differentiate the various types of hernias on the basis of physical exam;

   2. differentiate hernias from other causes of a groin masses;

   3. identify hernias needing emergent surgical repair;

2. list and interpret critical investigations of a patient who may have strangulation, ischemia, or bowel obstruction;

3. construct an effective management plan, including

   1. select patients in need of surgical consultation;

   2. counsel and educate patients on the risks associated with uncorrected hernias as well as strategies to reduce post-operative recurrence (especially with ventral hernias).