38 Hernias, Abdomen, Tech Flashcards
What forms the cremasteric muscles?
internal oblique
What forms the inguinal canal floor?
transversalis muscle
Where does the inguinal ligament come from?
external oblique
What forms where the inguinal ligament splays out to insert in the pubis?
Lacunar ligament
What comes from the transversalis, runs from asis to the pubis and is below the inguinal ligament?
ileopubic tract
Cooper’s ligament aka?
pectineal ligament
What runs medial to the cord structures?
vas deferens
What forms Hesselbach’s triangle?
rectus muscle, inferior inguinal ligament, and inferior epigastrics
What type of inguinal hernia is most common and comes from a patent processus vaginalis?
indirect hernia
What type of inguinal hernia has a lower risk of incarceration, rare in females, and has a higher recurrence than indirect?
direct hernia
What type of hernia has direct and indirect components?
Pantaloon hernia
What type of hernia occurs when the wall of the hernia sac is an organ?
sliding hernia
What are the 2 most common organs involved in a sliding inguinal hernia in women? and men?
ovaries or fallopian tubes
cecum or sigmoid
3 steps in repair of female with ovary in inguinal canal?
ligate the round ligament, return ovary to peritoneum, perform biopsy if looks abnormal
Inguinal hernia in children is almost always what type? and what is the treatment?
nearly always indirect, just perform high ligation (open sac prior to ligation)
Describe the Bassini repair
approximation of the conjoined tendon and transversalis fascia (superior) to the free edge of the inguinal ligament (inferior)
Describe the McVay repair
approximation of the conjoined tendon and transversalis fascia (superior) to Cooper’s ligament (pectineal ligament, inferior)
The McVay repair needs a relaxing incision where?
external abdominal oblique fascia
When is laparoscopic inguinal hernia repair indicated?
bilateral or recurrent
What is the advantage of the Lichtenstein mesh repair?
decreased recurrence due to decreased tension
What is the most common early complication following hernia repair?
urinary retention
What is the infection rate for inguinal hernia repair? and recurrence rate?
2%, 2%
What can occur secondary to dissection of the distal components of the hernia sac causing vessel disruption and thrombosis of spermatic cord veins?
testicular atrophy
Pain after hernia is usually caused by what? What is the tx?
compression of ilioinguinal nerve, local infiltration (diagnostic and therapueutic)
Loss of cremasteric reflex; numbness on ipsilateral penis, scrotum and thigh are sx of what?
ilioinguinal nerve injury
Where is the ilioinguinal nerve injury usually occur?
at the external ring; nerve runs on top of cord