Abdominal wall hernias
1. Big picture
Abdominal wall hernias are protrusions of intra-abdominal tissue through defects or weak points in the anterior/lateral abdominal wall, excluding the groin hernias discussed separately. The most important exam types are:
- Umbilical / paraumbilical hernia
- Epigastric hernia
- Incisional hernia
- Parastomal hernia
- Spigelian hernia
- Less common: lumbar, suprapubic, traumatic abdominal wall hernia
The examiner wants you to explain:
- What defect is present?
- What is inside the hernia?
- Is it reducible or complicated?
- Does the patient need emergency surgery or elective repair?
- Should repair be suture-based or mesh-based?
- Where should mesh be placed?
The key surgical danger is the same as all hernias:
A painful, tender, irreducible abdominal wall hernia with vomiting, obstruction, skin change, fever, tachycardia, or peritonitis is strangulated until proven otherwise.
Incisional hernias are especially important because they occur through incompletely healed surgical wounds and simple tension suture repair has a high recurrence risk, so modern repair usually aims for tension-free mesh reinforcement. ([Wikipedia][1])
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