Classic Intraoperative Inguinal Hernia Questions

Question 1

What is the first identifiable subcutaneous named layer

Answer 1

Scarpa’s fascia
(thin in adults)

Question 2

What is the name of the subcutaneous vein that is ligated

Answer 2

Superficial epigastric vein

Question 3

What happens if you cut the ilioinguinal nerve

Answer 3

Numbness of inner thigh or lateral scrotum
(usually goes away in 6 months)

Question 4

From what abdominal muscle layer is the cremaster muscle derived

Answer 4

Internal oblique muscle

Question 5

From what abdominal muscle layer is the inguinal ligament derived
(aka Poupart’s ligament)

Answer 5

External oblique muscle aponeurosis

Question 6

To what does the inguinal (Poupart’s) ligament attach

Answer 6

Anterior-superior iliac spine to the pubic tubercle

Question 7

What nerve travels on the spermatic cord

Answer 7

Illoinguinal nerve

Question 8

Why do some surgeons deliberately cut the ilioinguinal nerve

Answer 8

First they obtain preoperative consent and cut so as to remove the risk of entrapment and postoperative pain

Question 9

What is in the spermatic cord (6)

Answer 9

Cremasteric muscle fibers
Vas deferens
Testicular artery
Testicular venous plexus
Hernia sac
Genital branch of the genitofemoral nerve

Question 10

What is the hernia sac made of

Answer 10

Peritoneum (direct) or patent processus vaginalis (indirect)

Question 11

What attaches the testicle to the scrotum

Answer 11

Gubernaculum

Question 12

What is the most common organ in an inguinal hernia sac in men

Answer 12

Small intestine

Question 13

What is the most common organ in an inguinal hernia sac in women

Answer 13

Ovary/fallopian tube

Question 14

What lies in the inguinal canal in females instead of the VAS

Answer 14

Round ligament

Question 15

Where in the inguinal canal does the hernia sac lie in relation to the other structures

Answer 15

Anteromedially

Question 16

Preperitoneal fat on the cord structure

Answer 16

Cord lipoma

Question 17

What action should be taken if a suture is placed through the femoral artery or vein during an inguinal herniorrhaphy

Answer 17

Remove the suture as soon as possible and apply pressure (do not tie the suture down)

Question 18

What nerve is found on top of the spermatic cord

Answer 18

Ilioinguinal nerve

Question 19

What nerve travels within the spermatic cord

Answer 19

Genital branch of the genitofemoral nerve

Question 20

Borders of Hesselbach’s trainagle

Answer 20

Epigastric vessels
Inguinal ligament
Lateral border of the rectus

Question 21

What type of hernia goes through Hesselbach’s triangle

Answer 21

Direct hernia due to a weak abdominal floor

Question 22

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

Answer 22

Relaxing incision

Question 23

Aponeurotic attachments of the “conjoining” of the internal oblique and transverse abdominis to the pubic tubercel

Answer 23

Conjoint tendon

Question 24

How tight should the new internal inguinal ring be

Answer 24

Should allow entrance of the tip of a Kelly clamp but not a finger