Classic Intraoperative Inguinal Hernia Questions Flashcards
What is the first identifiable subcutaneous named layer
Scarpa’s fascia
(thin in adults)
What is the name of the subcutaneous vein that is ligated
Superficial epigastric vein
What happens if you cut the ilioinguinal nerve
Numbness of inner thigh or lateral scrotum
(usually goes away in 6 months)
From what abdominal muscle layer is the cremaster muscle derived
Internal oblique muscle
From what abdominal muscle layer is the inguinal ligament derived
(aka Poupart’s ligament)
External oblique muscle aponeurosis
To what does the inguinal (Poupart’s) ligament attach
Anterior-superior iliac spine to the pubic tubercle
What nerve travels on the spermatic cord
Illoinguinal nerve
Why do some surgeons deliberately cut the ilioinguinal nerve
First they obtain preoperative consent and cut so as to remove the risk of entrapment and postoperative pain
What is in the spermatic cord (6)
Cremasteric muscle fibers
Vas deferens
Testicular artery
Testicular venous plexus
Hernia sac
Genital branch of the genitofemoral nerve
What is the hernia sac made of
Peritoneum (direct) or patent processus vaginalis (indirect)
What attaches the testicle to the scrotum
Gubernaculum
What is the most common organ in an inguinal hernia sac in men
Small intestine
What is the most common organ in an inguinal hernia sac in women
Ovary/fallopian tube
What lies in the inguinal canal in females instead of the VAS
Round ligament
Where in the inguinal canal does the hernia sac lie in relation to the other structures
Anteromedially
Preperitoneal fat on the cord structure
Cord lipoma
What action should be taken if a suture is placed through the femoral artery or vein during an inguinal herniorrhaphy
Remove the suture as soon as possible and apply pressure (do not tie the suture down)
What nerve is found on top of the spermatic cord
Ilioinguinal nerve
What nerve travels within the spermatic cord
Genital branch of the genitofemoral nerve
Borders of Hesselbach’s trainagle
Epigastric vessels
Inguinal ligament
Lateral border of the rectus
What type of hernia goes through Hesselbach’s triangle
Direct hernia due to a weak abdominal floor
Incisions in the rectus sheath to relax the conjoint tendon so that it can be approximated to the reflection of the inguinal ligament without tension
Relaxing incision
Aponeurotic attachments of the “conjoining” of the internal oblique and transverse abdominis to the pubic tubercel
Conjoint tendon
How tight should the new internal inguinal ring be
Should allow entrance of the tip of a Kelly clamp but not a finger
