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ABSITE > Hernia > Flashcards

Hernia Flashcards

1
Q

spigelian hernia definition

A

through the aponeurotic layer between the rectus muscle medially and the semilunar line laterally
typcally between oblique fibers and insertion of external apo into rectus sheath
at or below the arcuate line “semicircularis” (loss of posterior rectus sheath)
small (usually 1-2 cm)

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2
Q

dx spigelian

A

CT or US

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3
Q

mgmt spigelian

A

must be repaired because of the high risk of incarceration resulting from their narrow neck

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4
Q

perineal hernia after APR

A

protrusion of intra-abdominal contents through a pelvic floor defect

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5
Q

mgmt of perineal hernia

A

transabdominal or combined perineal approach repair with mesh

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6
Q

lap vs open hernia repair in the setting of obesity?

A

relatively small defect, lap > open

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7
Q

most likely injured artery in open inguinal hernia repair?

A

inferior epigastric aa

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8
Q

mesh selection hernia repair, clean case

A

LIGHT, MACROPOROUS, Polypropylene mesh = permanent synthetic mesh that becomes incorporated into native tissue and has a low rate of recurrence.

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9
Q

mesh selection hernia repair, contaminated field

A

Polyglycolic acid mesh, an absorbable mesh, is often used in contaminated fields because there is no prosthetic material remaining over the long term; however, it does not provide long-term tissue support!!!!

vs

Biologic mesh is typically composed of an acellular collagen matrix that theoretically promotes neovascularization and native collagen deposition; thus, it can be used in contaminated fields. However, the high cost of biologic mesh makes it less appropriate for routine repair in clean operative field

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10
Q

elective hernia a1c, BMI, tobacco

A

a1c <8%, BMI <40, tobacco 4-8 wks stop

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11
Q

decision to use mesh

A

if defect >3cm (primary closure recurrence is like 50%).

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12
Q

parastomal hernia incidence

A

highest for colostomies and occurs in up to 50% of stomas

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13
Q

mgmt parastomal hernia

A

laparoscopic Sugarbaker repair for IPOM: place UNDERLAY mesh as a flat sheet, lateralize stoma as it exits the abdomen

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14
Q

diastasis recti

A

NOT A TRUE HERNIA.

weakening of the linea alba, while the rectus fascia is intact

not associated with a risk of strangulation

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15
Q

lumbar hernia of Grynfeltt

A

between the 12th rib/LAT, paraspinal (&serrator posterior) muscles, and the internal oblique muscle; therefore, this is the mostly likely diagnosis

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16
Q

lumbar hernia of Petit

A

bordered by lat dorsi, iliac crest, and external oblique

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17
Q

Richter hernia

A

Mostly inguinal or femoral canal vs incisional
Involve antimesenteric border of the bowel (typically the distal ileum)

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18
Q

Richter mgmt

A

they incarcerate easily; so preperitoneal approach

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19
Q

Littre hernia

A

with meckel’s diverticulum in it; mostly inguinal 50%>. umb , femoral

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20
Q

Obturator hernia

A

obturator canal = union of pubic bones and ischium

usually presents with bowel ischemia, Howship Romberg sign (inner pain with internal rotation)

can help wtih repair by incising obturator canal

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21
Q

Anterior vs posterior component separation

A

Ant: higher wound morbidity which includes superficial or deep surgical site infection, seroma, wound dehiscence, wound necrosis, and the development of a chronic draining sinus

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22
Q

How much regain of domain do you get from anterior component separation?

A

10 cm on each side

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23
Q

anterior component separation steps

A
  1. dissect SQ from ant rectus sheath and external aponeurosis
  2. ext oblique incised 2 cm lateral to rectuas abdominis
  3. ext oblique separated from internal oblique
  4. dissect down to posterior axillary line
  5. more length by incising posterior rectus sheath above the arcuate line
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24
Q

diaphragmatic injury closure, traumatic

A

debride devitalized edges, then use nonabsorbable (polypropylene ie) interrupted or running in locked fashion

bridging mesh if absolutely necessary

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25
Q

complete diaphragmatic avulsion from chest wall injury mgmt

A

reattach primarily using PDS (?? should be using non-absorbable…) sutures circumferentially around the ribs

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26
Q

swiss cheese hernia repair

A

overlap between mesh adn abdominal wall by 3-5 cm

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27
Q

ilioinguinal injury

A

prox thigh numbness/burning

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28
Q

ilioinguinal course

A

exits abdominal wall lateral to internal inguinal ring and typically runs with cremasteric fibers along (but not in) the cord

most commonly injured at external ring when opening the oblique up

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29
Q

post inguinal hernia pain

A

10% of patinets

6 mo = chronic

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30
Q

mgmt post inguinal hernia pain

A
  1. nerve block
  2. triple or selective neruectomy
  3. groin exploration and mesh removal
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31
Q

MC hernia of all time

A

indirect inguinal hernia (lateral to epigastrics) from patent processus vaginalis

32
Q

MIS inguinal hernia repari

A

TEP or TAPP

33
Q

mcvay

A

tissue based repair (good fro contaminated; can’t do Lichtenstein)

34
Q

onlay repair mesh overlap

A

4-6 cm

35
Q

conjoint tendon

A

aponeurosis of internal oblique FASCIA and transversalis FASCIA

36
Q

lacunar ligament

A

where inguinal ligament splays to insert into the pubis

37
Q

coopers ligament

A

pectineal ligament posterior to femoral vessels; lies against the BONE

38
Q

sliding inguinal hernia

A

RP organ involved (F: ovary, M: cecum/sigmoid)

39
Q

sliding inguinal hernia mgmt ovary

A

ligate round ligament (runs in inguinal canal in F)

40
Q

bassini repair

A

approximate conjoint tendon to free edge of cooper’s ligament (shelving edge, inferior) for inguinal hernia

shouldice: bassini in 4 layers

41
Q

mcvay repair (ing or femoral repair)

A

approximate Conjoint tendon to Cooper’s ligament requires relaxing suture in external oblique

42
Q

ilioinguinal nerve injury (runs on top of cord; injured at external ring)

A

loss of cremasteric reflex; numbness ipsilateral penis/thigh

43
Q

where do cord structures run relative to the indirect inguinal hernia

A

the sac is DEEP to cremasters
the cord is POSTERIOR and INFERIOR to sac

44
Q

genitofemoral nerve injury

A

genital branch: cremaster loss, scrotum numbness
femoral: numbness upper lateral thigh

45
Q

femoral canal bounds

A

posterior: Coopers
anterior: inguinal
lateral: fem vein
medial: lacunar

46
Q

when to repair umbilical hernia

A

5 YO

47
Q

polypropylene fibroblast growth

A

YES

48
Q

PTFE fibroblast growth

A

NO

49
Q

incarceration risk inguinal hernia

A

0.18% per year

50
Q

umbilical contents –> adult

A

vitelline duct = omphalomesenteric duct (can become Meckel’s)
urachus = median umbilical ligament
umbilical arteries x 2 = medial umbilical ligaments
umbilical vein = round ligament of the liver (ligamentum teres)

51
Q

when does midgut hernia?

A

herniates at 6 wks, returns at 10 wks

52
Q

omphalocele vs gastroschisis defect

A

omphalocele: through umbilical stalk
gastroschisis: inferior/RIGHT of umbilical stalk

53
Q

when to repair umbilical hernia?

A

5 YO ( before go to school)

54
Q

when to primarily repair umbo hernia

A

< 1 cm

55
Q

cremasters are made of?

A

internal oblique muscle fibers

56
Q

contents of spermatic cord

A

cremasters
testicular artery
vas def
pampiniform plexus
ilioinguinal N
genital branch of genitofemoral N.

57
Q

MC nerve injury in LIchtenstein

A

ilioinguinal (when opening ext oblique)

58
Q

MC nerve injured in lap/robotic hernia

A

lateral femoral cutaneous (tack during lateral dissection)

59
Q

morbid obese hernia

A

staged with bari first

60
Q

smoking hernia

A

just stop before elective repair

61
Q

highest recurrence of mesh placement lOCATION

A

inlay

62
Q

best LOCATION mesh

A

UNDERLAY

63
Q

amyand hernia

A

appendix in inguinal hernia sac

64
Q

corona mortis

A

branch between obturator and external iliac artery (arterial bleeding tack mesh to coopers)

65
Q

location of mesh

A

Intraperitoneal
underlay: preperitoneal
sublay: retrorectus
inlay: interposition
overlay: subQ

66
Q

IPOM

A

keyhole technique… intraperitoneal only tac it up

67
Q

congenital diaphragmatic hernia

A

50% rate for chronic pulmonary disease regardless of repair

68
Q

congenital diaphragmatic hernia lap vs open

A

LAP has more recurrence

69
Q

obturator canal bounds

A

contents: obturator aa/v/N
1cm x 2-3cm long
inferior to cooper’s ligament
medial to femoral vessels

70
Q

how to fix obturator hernia

A

if threatened bowel: TRANSABDOMINAL
you may need to incise obturator membrane to reduce (incise medially and downward direction to avoid vessels)

if large, needs mesh (all sites)
close peritoneum

71
Q

myopectineal orificie

A

space covered in TAPP mesh repair (covers indirect, direct, and femoral areas)

72
Q

if incarcerated symptomatic in pregnant woman, when to operate on umbilical hernia?

A

2nd trimester

73
Q

fothergill’s sign

A

rectus sheath hematoma is bigger & more painful with flexed rectus muscle

74
Q

desmoid tx

A

WLE if possible
if not, sulindac and tamoxifen

75
Q
A

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