abdominal wall & groin hernias Flashcards
operative approaches that can address both inguinal and femoral hernias:
TEP repair and McVay
vicryl (polyglycolic-acid mesh) properties:
absorbable; can be used in contaminated fields
polypropylene mesh properties:
becomes incorporated into native tissue
PTFE (Polytetrafluoroethylene) mesh properties:
macroporous, lightweight mesh that allows higher bacterial clearance than microporous; does not incorporate into native tissue
biologic mesh properties:
composed of acellular collagen matrix and theoretically promotes neovascularization and collagen deposition; can be used in contaminated fields
what nerve supplies sensation to the upper anterior thigh and groin
genital branch of genitofemoral nerve
ideal overlap for lap ventral hernia with intraperitoneal mesh placement:
3-5 cm
most common groin hernias in males and females
indirect inguinal hernias
location of femoral hernias
lateral to pubic tubercle and below inguinal ligament
borders of femoral canal:
posterior - Cooper’s ligament
anterior - inguinal/poupart ligament
lateral - femoral vein
medial - lacunar ligament (junction of iliopubic tract and coopers)
direct hernia is a weakness of ____
transversalis fascia
which type of groin hernias require repair because of their high risk of incarceration and strangulation
femoral hernias
indirect hernia is ____ to inferior epigastric vessels
lateral
contents of inguinal canal:
spermatic cord (or round ligament), ilioinguinal nerve, genital branch of genitofemoral nerve
most commonly injured nerves in laparoscopic inguinal hernia repair:
genitofemoral and lateral femoral cutaneous
type of biologic mesh that delays neovascularization and cellular infiltration; uses chemical to render the collagen of the biologic matrix less prone to degradation by naturally occurring collagenases; acts like a foreign body and becomes encapsulated with fibrous tissue
cross-linked biologic mesh
type of biologic mesh that promotes vascularization and cellular ingrowth
non-crosslinked biologic mesh
in what tissue plane to biologic meshes work best?
when placed between two layers of vascularized tissue that promote fibroblate and vessel ingrowth within the scaffold
suturing properties important for fascial closure to prevent incisional hernia:
suture length to wound ratio of higher than 4:1; 2-0 monofilament running suture placed 5-8mm from wound edge and 4-5mm apart
true or false: mesh in the retrorectus position has a lower complication rate (including recurrence) than overlay or underlay positions
true
features of large pore, lightweight mesh:
better tissue incorporation of mesh which is thoguht to help reduce recurrence and infection
artery most likely to be injured during open inguinal herniorrhaphy
inferior epigastric - branch of external iliac immediately above the inguinal ligament
True or false. asymptomatic inguinal hernias can safely be observed due to low risk of incarceration
true. less than 1% risk
Which nerve in open inguinal hernia surgery will result in numbness of the ipsilateral thigh and scrotum if injured?
genitofemoral nerve - sensation to thigh and groin
True or false. Watchful waiting/monitoring can be used when a Spigelian hernia is detected.
False. All spigelian hernias should be repaired
True or false. The use of acellular dermal matrix results in lower rates of SSI when used for abdominal wall repair in the presence of heavy contamination.
True. additionally less hernia recurrences and fewer complications compared with synthetic mesh
for example - abdominal hernia with enterocutaneous fistula
True or false. Biologic mesh offers lower rates of fistula recurrence compared to synthetic mesh after repair.
true
True or false. SSI and recurrence of a hernia is higher for primary fascial closures with mesh reinforcement than bridged repairs with mesh.
False. bridged repair has high complications for both biologic and synthetic
True or false. There is no advantage to using biologic mesh rather than synthetic mesh for crural closure and parastomal hernias.
True.
