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Hernias Flashcards

1
Q

Indirect and femoral hernias occur more commonly on the right;

A

Due to slower descent of the right testis and delayed atrophy of processes vaginalis on right

Also sigmoid prevents femoral hernias from forming on left side

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2
Q

Strangulation rates of femoral hernias?

A

15-20%, thus all femoral hernias need repair

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3
Q

Cremasteric fibers arise from?

A

Internal oblique

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4
Q

Bassini repair?

A

Suturing conjoint tendon to the inguinal ligament

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5
Q

Cooper’s ligament repair AKA:

A

McVay repair

Obliterates femoral space without a mesh

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6
Q

Main complication after open inguinal hernia repair?

A

Chronic groin pain

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7
Q

Superior Lumbar triangle (Grynfeldt hernia)

A

More common

12th rib, paraspinal muscles, internal oblique

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8
Q

Inferior lumbar triangle; Petit triangle;

A

Iliac crest, lats, external oblique

Less common

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9
Q

Difference between anterior/posterior component separation?

A

Anterior; division of external oblique

Posterior: division of Tranversus abdominis

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10
Q

Performing an anterior component separation:

A

Mostly done for anterior abdominal wall defects

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11
Q

McVay repair:

A

Tissue based repair suturing the conjoint tendon to the Cooper’s ligament
A relaxing incision on the rectus sheath often required
Good for inguinal and femoral hernias

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12
Q

Abdominal wall mesh placement;

A

Sublay retromuscular mesh placement after primary fascial closure has the lowest rates of ventral hernia recurrence

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13
Q

Triangle of doom;

A

Bounded by vas deferens medially, gonadal vessels laterally, contains external iliac artery/vein

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14
Q

Triangle of pain;

A

Apex is at the internal inguinal ring

Bounded anteriorly by inguinal ligament and medially by gonadal vessels

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15
Q

McVay repair;

A
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16
Q

When tacking a mesh to the shelving edge of the inguinal ligament, why should we tack sutures inferior to the shelving edge?

A

Can get into external iliac artery/vein

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17
Q

Inferior lumbar hernia;

A

Lats, iliac crest, external oblique

18
Q

Lap view of groin hernia anatomy;

A
19
Q

Borders of the inguinal cal:

A

Anteriorly; EO aponeurosis

Posteriorly; Tranversalis fascia

Superiorly: Conjoint tendon

Inferiorly; inguinal ligament

20
Q

Borders of femoral canal;

A

Laterally femoral vein

medially lacunar ligament

Anteriorly inguinal ligament

21
Q

Sugarbaker vs keyhole slit for PH repair?

A

Lap Sugarbaker seems superior

22
Q

Medial rotation and extension of hip?

A

Howship Romberg sign used to identify an obturator hernia

23
Q

Anterior component separation?

A

Release external oblique

24
Q

Posterior component separation?

A

Release tranverse abdominus

25
Q

Sugarbaker or keyhole slit for parastomal hernia repair?

A

Sugarbaker

26
Q

During laparoscopic hernia repair, tacks should not be placed inferior to the inguinal ligament and lateral to the gonadal vessels; why?

A

Can injury the femoral branch of genitofemoral nerve and lateral femoral cutaneous nerve

27
Q

Triangle of doom?

A

Bounded laterally by spermatic vessels
Bounded medially by vas deferens

Contains external iliac A/V

28
Q

Triangle of pain;

A

Bounded by inguinal ligament superiorly
Bounded by spermatic vessels medially

Contains femoral n, femoral branch of genitofemoral n, anterior femoral cutaneous, lateral femoral cutaneous

29
Q

MC nerve injured during a laparoscopic hernia repair?

A

Genitofemoral nerve

30
Q

Course of ilio-inguinal and ilio-hypogastric nerves?

A

Course between the internal oblique and tranverse abdominus

31
Q

Superior lumbar hernia of Grynfeldt;

A

Lat
Serratus posterior
Posterior border of internal oblique

32
Q

Inferior lumbar hernia of Petit:

A

Lat
Iliac crest
Ext. oblique

33
Q

The lumbar triangle of petit;

A

Lat

External oblique

Iliac crest

34
Q

Collagen types and hernias;

A

See increased type III and decreased type I collagen in hernias

35
Q

Types of paraesophageal hernias?

A

I; MC; GE junction migrates above diaphragm

II: GE junction in normal anatomical location; fundus herniates above diaphragm

III: mixed type I/II

IV: organs other than stomach herniate into chest

36
Q

For incarcerated femoral hernias, what approach indicated?

A

Inguinal approach recommended

37
Q

Umbilical hernias in children?

A

Can observe

Most will close by 4-5 y/o

38
Q

Boundaries of femoral canal;

A

Ant: inguinal ligament
Post; Coopers/pectineal ligament
Medially; Lacunar ligament
Lateral; fem vein

39
Q

Lowest recurrence of parastomal hernia repair?

A

Laparoscopic mesh *sugarbaker technique

40
Q

Left v Right CDH?

A

Left sided hernias have better prognosis

Liver makes dissection harder on the right side

41
Q

In indirect inguinal hernias, where do we normally find the sac?

A

Deep to cremaster and anterior/superior to spermatic cord structures

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