Hernia Surgery Flashcards
Identify the triad of anatomic sites of abdominal wall weakness with a potential for hernias.
a- groin, ventral line, umbilicus
b- inguinal rings, femoral canal, incision
c- inguinal canal, femoral rings, umbilicus
d- ventral line, aponeurosis, inguinal canal
inguinal canal, femoral rings, umbilicus
What composes the lining of a herniated abdominal sac?
a- fascia
b- peritoneum
c- muscularis
d- rectus abdominis muscle
peritoneum
Select the triad of the boundaries of the Hesselbach triangle.
a- inguinal ligament, rectus abdominus muscle, deep epigastric vessels
b- rectus abdominis muscle, cooper ligament, aponeurosis
c- Scarpa’s fascia, deep epigastric vessels, externa oblique muscle
d- inguinal ligament, inguinal canal, cooper ligament
inguinal ligament, rectus abdominus muscle, deep epigastric vessels
Select the most common hernia that occurs in both males and females and name the side on which it would most likely occur
a- direct femoral hernia on the left
b- indirect inguinal hernia on the right
c- indirect femoral hernia on the left
d- direct inguinal hernia on the right
direct inguinal hernia on the right
Femoral hernias occur more frequently in which group of individuals?
a- postoperative obese patients
b- newborns
c- weight lifters
d- females
females
While direct and indirect hernias both protrude into the inguinal canal and represent tears in the transversalis fascia, which one of the two occurs within the Hesselbach triangle?
a- direct inguinal hernia
b- indirect inguinal hernia
c- both options occur within the triangle
d- neither option occurs within the triangle
direct inguinal hernia
Ryan has an indirect hernia that is characterized by a small neck, thin walls, and close attachment to the cord structures. Marc has a hernia with a short, wide neck, and a thick-walled sac. Based on this description, Ryan has a(n) ____________ hernia and Marc has a(n) __________ hernia.
a- acquired; congenital
b- reducible; nonreducible
c- congenital; acquired
d- pantaloon; saccular
congenital; acquired
Hernia-entrapped viscera, typically loops of small intestine, will result in intestinal obstruction with resulting pain, vomiting, and distention. What is the appropriate descriptive diagnosis of this condition?
a- nonreducible hernia
b- incarcerated hernia
c- torsion of the hernia sac
d- gangrenous bowel
incarcerated hernia
Depending on their location, hernias are classified as direct inguinal, indirect inguinal, femoral, umbilical, incisional, or epigastric. Hernias in any of these groups are either reducible or nonreducible. The characteristic “reducible” hernia can be described as a hernia
a- that does not require surgical repair
b- that is an emergent diagnosis
c- with visceral content that can be returned to the abdomen
d- with a narrow sac neck that is closed with adhesions
with visceral content that can be returned to the abdomen
Of the open hernia procedures listed below, which classes hernia procedure is considered, by some surgeons, to not be anatomically correct because the superior transversalis fascia is sutured to the inguinal ligament instead of to the inferior portion of the transversalis fascia or the Cooper ligament?
a- Shouldice repair
b- Bassini repair
c- McVay repair
d- Cooper repair
Bassini repair
Which two similar hernia repair approaches reestablish the integrity of the transversalis fascia and simultaneously reestablish and strengthen the posterior inguinal floor by sewing the transversalis fascia to the Poupart ligament?
a- the Shouldice and the McVay ligament repair
b- the Bassini and Shouldice repair
c- the McVay and the Cooper ligament repair
d- the Shouldice and the cooper ligament repair
the McVay and the Cooper ligament repair
The anterolateral abdominal wall consists of an arrangement of muscles, fascial layers, and muscular aponeuroses lined interiorly by peritoneum and exteriorly by skin. The key landmark of the______ designates the roof of the inguinal canal and the key landmark of the ____ designates the floor of the inguinal canal
a- external oblique aponeurosis; transversalis aponeurosis and fascia
b- lateral rectus abdominis; transversalis aponeurosis and fascia
c- external oblique aponeurosis; Poupart ligament
d- transversalis aponeurosis and fascia; Cooper ligament aponeurosis
external oblique aponeurosis; Poupart ligament
The transabdominal preperitoneal path (TAPP) hernia repair and the totally extraperitoneal path (TEP) repair differ in the manner in which access is gained to the preperitoneal space. Which of the two provides access to the preperitoneal space without entering the peritoneum?
a- The TEP technique
b- the TAPP technique
c- Both techniques require access into the peritoneal compartment
d- Neither technique enters the peritoneal compartment
The TEP technique
Charles Wilkins had a laparoscopic hernia repair with good results and an uneventful recovery. Weeks later, as he reviewed his hospital bill, he noted that he had been charged for a very expensive preperitoneal distention balloon, polypropylene mesh, an endomechanical stapler, and three endosurgical trocars. What hernia repair technique was probably performed on Charles?
a- TAPP repair
b- Laparoscopic Bassini repair
c- TEP repair
d- Mesh-plug insertion repair
TEP repair
A direct inguinal hernia occurs
Medial to the inferior epigastric artery
What structures are located in the inguinal canal?
Spermatic cord/round ligament
Describe a pantaloon hernia.
A combination direct and indirect hernia
Structure covers the spermatic cord and contracts to make the testicles ascend in the scrotum?
Cremaster muscle
inguinal ligament - a thickened lower border of external oblique
Poupart’s ligament
The structure that becomes defective and is susceptible to indirect, direct, or femoral hernias
posterior inguinal floor
Iliopectineal line; site of insertion of the transverse aponeurosis along the superior ramus from the symphysis pubis, laterally to the femoral sheath
Cooper ligament
What extends superiorly and inferiorly from above the xiphoid process to the pubis?
linea alba
direct hernias protrude into the ___________________________, but not into the ________________________, and therefore rarely into the scrotum
a.) spermatic cord, inguinal canal
b.) inguinal canal, spermatic cord
b.) inguinal canal, spermatic cord
Which of the following anatomy is not part of the inguinal canal?
a. deep epigastric vein
b. spermatic cord
c. Cooper’s ligament
d. internal ring
a. deep epigastric vein
Which of the following hernias deal with only a portion of the bowel passing through the hernia ring?
a. Richter
b. Shouldice
c. Cooper
d. McVay
a. Richter
Approximates the transversalis fascia superior to the inferior insertion of the transversalis fascia along the Cooper ligament. Accompanied by a relaxing incision to reduce tension on the suture line.
McVay (Cooper Ligament) Repair
The conjoined tendon and the shelving edge of the inguinal ligament are sutured together in the inguinal ring.
Bassini repair
Most common sliding hernias involve the _________ in direct hernias
bladder
Most common sliding hernias involve the ____________ in left indirect hernias
sigmoid colon
Most common sliding hernias involve the ____________ right indirect inguinal hernias
cecum
Special type of strangulated hernia, only a part of the circumference of the bowel is incarcerated or strangulated.
Richter hernia
Protrusions of fat through defects in the abdominal wall between the xiphoid process and the umbilicus
epigastric hernia
Which method provides access to the preperitoneal space without entering the peritoneal cavity; uses balloon to separate layers
method: TEP
Which side do hernias more commonly occur?
right
Semilunar lines of Spieghel
lateral margins of rectus
Skin prep for herniorrhaphy
Begin at incision
Extend from umbilicus to mid-thigh
Down to table on both sides
Genitals prepped last
Incision for hernia
Transverse or oblique.
Hernia Wound Classification:
Class I
Class III if bowel is strangulated
Identify the red pointer
Clue: Passageway in the groin area through which the testes travel as they descend from the abdomen to the scrotum
Identify the red pointer
Clue: Ligament extending from pubic bone to anterior superior iliac spine, forming lower border of abdomen
inguinal ligament
Identify the red pointer
Clue: Passageway in the groin area through which the testes travel as they descend from the abdomen to the scrotum
Inguinal canal
Identify the red pointer
Clue: Beginning of the canal where the spermatic cord passes through
Internal ring
Identify the red pointer
Clue: Structures that course throughout entire length of adductor canal
Femoral artery and vein
Identify the red pointer
Clue: Bundle of fibrous connective tissue containing the ductus deferens, blood and lymphatic vessels, and testicular nerve
Spermatic cord
Identify the red pointer
Clue: The point at which the spermatic cord crosses a defect in the external oblique aponeurosis
External ring
