Hernia

Question 1

Define hernia

Answer 1

Protrusion of viscus or part of viscus through wall containing it

Question 2

Parts of hernia

Answer 2

Sac
Contents
Defect
Blood supply

Question 3

What are the hallmarks of uncomplicated hernia

Answer 3

Reducability and cough impulse

Question 4

Obstructed/invarcerated hernia are

Answer 4

Irreducible
No cough impulse
Blood supply is intact

Question 5

Strangulated hernia

Answer 5

Obstructed and compromised blood supply

Question 6

Dictum about hernia

Answer 6

All obstructed hernia are considered strangulated unless proved otherwise

Question 7

What is taxis

Answer 7

Process of reduction of hernia

Question 8

Forceful taxis should be avoided in

Answer 8

Obstructed and strangulated hernia

Question 9

Based on content of hernia

Answer 9

Omentocele-omemtum
Enterocele-bowel

Question 10

Omentocele vs enterocele diffrentiation

Answer 10

Omentocele

Palpatipon–doughy consistensy
Easy to reduce first part
Difficult to reduce second part

Enterocele

Visible peristalsis
Difficult to reduce first part
Easy to reduce second part
Percussion–tympanic note
Auscultation-bowel sound

Question 11

Depending on the content of hernia

Answer 11

Meckels diverticulum-littres hernia

Appendix-amayand hernia

Question 12

Surgical management of hernia

Answer 12

Herniotomy
Hernioraphy
Hernioplasty

Question 13

Herniotomy procedure

Answer 13

Identify the sac and push the contents inside

If the sac is opened it should be closed and reduced

Don’t do anything to defect

High recurrence rate

Question 14

Herniotomy is the treatment of choice for

Answer 14

Congenital inguinal hernias

Congenital hydrocele

Question 15

Herniorraphy

Answer 15

Same 2 steps as in herniotomy

Step 3–suture two edges together

Question 16

Most common cause of failure of herniorraphy

Answer 16

Increased tension in repair

Question 17

Examples of herniorraphy technique

Answer 17

BASSINI
SHOULDICE
MAYO

Question 18

Herniorraphy is indicatee in

Answer 18

Infected and strangulated hernia

Question 19

Hernioplasty

Answer 19

Step 3-mesh over the defect

Question 20

Least recurrent hernia surgery

Answer 20

Hernioplasty
Tension free

LICHTENSTEINS TENSION FREE MESH HERNIOPLASTY

Question 21

Meshes in hernioplasty

Answer 21

Synthetic

Avoided in infection and strangulation

Bilogical

Can be used in infection

Question 22

Biological mesh examples

Answer 22

Acellular humar dermis (alloderm)
Acellular porcine dermis

Question 23

Synthetic mesh ex

Answer 23

Prolene mesh
Polyester mesh
VIPRO -Vicryl+prolene
Poly tetra fluoro ethylene (PTF)

Question 24

Syntheic meshes types

Answer 24

Solid mesh

Need to fix them with sutures and staplers

Net mesh

Fibrous tissue can grow through pores they can remain in place without suture

Question 25

Mesh material

Answer 25

Prolene mesh

Strong
Hydrophobic

Polyester

Hydrophilic(risk infection)
But due to rapid ingrowth into mesh infection prevented

Poly tetra fluro ethylene mesh (solid mesh)

Does not become adherent to tissue

Can be placed intraperitoneal mesh

Fenestrated PTFE mesh allows peritomeum to grow through

Question 26

Mesh shrinkage

Answer 26

Upto 50% shrinkage can occur
Pain

A largeesh shoud be used atleast 5cm overlap on all sides

Question 27

Mesh depending onweight

Answer 27

Low –<40gm/m2

Hig weight –>80 gm/m2

Question 28

What kinda mesh to choose

Answer 28

Low weight
Thin fibres
Large pores

Question 29

Plug mesh

Answer 29

Problem

Increased collegen deposition and meshoma