Anterior Abdominal Wall (Hernias)

Question 1

Def of Hernia

Answer 1

protrusion of a viscus or other structure beyond normal coverings of cavity in which
it is contained

Question 2

Elements of hernia

Answer 2

sac, contents and a neck

Question 3

Complications of hernias

Answer 3

: incarceration, intestinal obstructions, strangulation

Question 4

What is Taxis?

Answer 4

: non-operative treatment of intestinal obstruction = manual reposition

can be done if reducible and no signs of strangulation must be done within 2 hrs

Question 5

Def of Strangulated hernia

Answer 5

: irreducible hernia with ischaemic or necrotic contents

Question 6

Def of Recurrent Hernia

Answer 6

Hernia recurring after previous hernia repair

Question 7

Types of anterior abdominal wall hernias

Answer 7

groin (inguinal*, femoral), umbillical, epigastric, spigellian and incisional

• can be direct or indirect

Question 8

Anatomy of inguinal canal

Answer 8

-anterior wall (aponeurosis of external oblique m)

-posterior wall (transverse fascia)

-superior wall (arching fibres of internal oblique m and traverse
abdominis m)

-inferior wall (in-rolled edge of inguinal ligament)

-internal ring (round lig or
spermatic cord emerge through transverse fascia)

-external inguinal ring (V-shaped opening of anterior wall immediately superior to pubic tubercle)

Question 9

Anatomy of femoral canal

Answer 9

Anterior wall (inguinal ligament)

posterior wall (iliopectineal lig),

medial wall (lacunar part of inguinal ligament),

lateral wall (femoral vein)

Question 10

Most common type of anterior abdominal wall hernia:

Answer 10

inguinal hernia, 80% of them

Question 11

Contents of the inguinal canal

Answer 11

Males: spermatic cord and the genital branch of the genito-femoral nerve

Females: round ligament of the uterus and the ilioinguinal nerve

Question 12

Types of inguinal hernias:

Answer 12

direct (sac doesn’t protrude through the inguinal canal),

indirect (sac protrudes through inguinal canal)

Question 13

Def of Epigastric hernia

Answer 13

: protrusion of preperitoneal fat through fascial defect in the decussating
fibres of supraumbilical portion of linea alba, peritoneal sac may accompany fat through the
defect, containing omentum or rarely bowel

Question 14

Def of Spigelian Hernia

Answer 14

: interparietal hernia in the line of linea semilunaris* (lateral margin of rectus
sheath, runs from tip of 9th costal cartilage to pubic crest)

*semilunar line - curved teendinous intersection found between lateral wall of rectus abdominus and external obliques

Question 15

Def of Incisional Hernia

Answer 15

occurs through the wound (cicatrix) of a previous operation (postoperative
complication

Question 16

What are the types of adult umbilical hernias? What is the difference between them?

Answer 16

True umbilical hernia: protrusion through umbilical scar tissue everting the umbilicus

Para-umbilical Hernia: develops at the superior aspect between the umbilical vein and the upper margin of the umbilical ring (weakest area of the umbilical scar). The hernia displaces the scar which lies below and slightly to one side.
Para-umbilical are more common than true.

Question 17

Def of Richter’s Hernia

Answer 17

contains part of the circumference of bowel wall, which can cause strangulation without obstruction

Question 18

Def of Maydl’s Hernia

Answer 18

contains two adjacent loops of bowel, segment between loops may be strangulated

Question 19

Def of Littre’s Hernia

Answer 19

hernia contains a Meckel’s diverticulum

Question 20

How can you distinguish femoral from inguinal hernia?

Answer 20

The upper medial border of a femoral hernia is always below and
lateral to the pubic tubercle.

Question 21

Why should you never try manual reposition in strangulated umbilical hernias in adults?

Answer 21

Manual repositioning (taxis) in strangulated adult umbilical
hernia may shift strangulated bowel loop from one to other
loculations (loculated nature of the hernia sac!) = false-positive
success of taxis.

Question 22

62-year-old man is in the operating room undergoing an open left inguinal hernia repair. A large indirect sliding hernia is found, during the dissections, the sigmoid colon is inadvertently injured. The colotomy is easily repaired with sutures. Which of the following
hernia repairs should be used in this situation?

Answer 22

Bassini Repair
The Bassini technique for inguinal hernia repair involves suturing the transversalis fascia and the conjoined tendon to the inguinal ligament behind the spermatic cord with monofilament nonabsorbable suture. It also involves the Tanner slide, a vertical relaxing incision in the anterior rectus sheath intended to prevent tension.

Question 23

Which type of hernia gets incarcerated most often and should be repaired as soon as it is diagnosed?

Answer 23

Femoral Hernia

Question 24

The inguinal canal contains in men?

Answer 24

Spermatic cord

Question 25

Which is the most commonly used hernia repair nowadays?

Answer 25

Lichtenstein repair, mesh placed between abdominal wall to reinforce it

Question 26

Which internal organs can be found in the hernia sac of an
inguinal hernia?

Answer 26

Omentum and small intestines. sigmoid colon

Question 27

A bulge or lump in the inguinal region and scrotum apart from inguinal hernia may be
a. Varicocele
b. Testicular torsion
c. Femoral hernia
d. Hidradenitis of inguinal apocrine glands
e. So all of the above

Answer 27

e

Question 28

How many hours after the onset of the complaints a surgeon may consider non-operative
treatment (taxis) for incarcerated inguinal hernia:

Answer 28

2 hrs

Question 29

Why is Richter’s hernia (rare) so dangerous?

Answer 29

It can result in strangulation in the absence of intestinal
obstruction.

Question 30

Posterior wall of inguinal canal (used in most hernia repairs):

Answer 30

transverse abdominis m, and
transverse fascia

Question 31

. Rare presentation of inguinal hernia (pantaloon hernia), what is specific for this type of
hernia?

Answer 31

There is both an indirect and direct hernia component

Question 32

Umbilical hernias in adults are largely acquired, resulting from?

Answer 32

obesity, lifting heavy objects, large benign or malignant intraabdominal tumours, repeat pregnancy

Question 33

Why is loss of abdominal domain a problem in incisional hernia repair?

Answer 33

Leads to abdominal
compartment syndrome and acute respiratory failure

Question 34

Types of diaphragmatic hernia:

Answer 34

Posterolateral Bochdalek,
Anterior Morgagni
Hiatal hernia

Question 35

Types of Eosophageal Hernia

Answer 35

Sliding (most common)
paraesophageal
type 3 - mixed