HERNIA

Question 1

management of Incarcerated and strangulated hernias

Answer 1

rendelenburg position during induction of anesthesia to decrease the likelihood that the hernia will reduce spontaneously.

If: spontaneous reduction of the hernia bowel will need to be inspected,

• typically be accomplished through the opened hernia sac.
• alternatively, laparoscopy can be used to evaluate bowel viability.

On laparoscopy, the presence of bloody fluid in the abdomen increases the suspicion of strangulated, gangrenous tissues.

When intestinal gangrene is present:
bowel resection
frequently be performed through the groin incision;

however, if the groin incision does not provide adequate exposure, an abdominal exploration (open or laparoscopic) may be needed.

Question 2

Maneuvers to try to reduce federal hurry up intraoperative

Answer 2

try traction from above within the preperitoneal space
and
pressure from below the femoral ring on the anterior thigh.

Question 3

If the femoral hernia cannot be reduced

Answer 3

Incise lacunar ligament to enlarge the femoral ring.

still not adequate,

the inguinal ligament can be transected just above the femoral ring; however, this maneuver is rarely needed.

Once the repair is completed, the inguinal ligament should be reapproximated.

Question 4

Treatment of infected mash after Lichtenstein repair

Answer 4

Tissue repair

Cooper’s ligament to the conjoined tendon

Transitional stitch to femoral sheath then shelving edge (which is the inguinal ligament)