Hernias Flashcards
Superficial and fatty fascial layer
Camper’s
Deep and membranous fascial layer
Scarpa’s
Superior to the arcuate line of Douglas, the anterior sheath is composed of the
EO and IO aponeuroses
Superior to the arcuate line of Douglas, the posterior sheath is composed of the
IO aponeurosis and transversalis fascia
Inferior to the arcuate line, the posterior sheath is composed only of
transversalis fascia
Deep inguinal ring arises from
Transversalis fascia
Superficial inguinal ring arises from
External oblique aponeurosis
Arises from thickened portion of EO and connects the anterior superior iliac spine to the pubic tubercle.
Inguinal (Poupart’s) ligament
Medial, fan-shaped aspect of inguinal ligament that joins inguinal ligament at the pubic tubercle to the pectineal line of pubis.
Lacunar (Gimbernat’s) ligament
Arises from the inferior aspect of transversalis fascia, parallel and deep to the inguinal ligament.
Iliopubic tract
Arises from a thickening of the fascia at the pectineal line and appears to extend from the lacunar ligament.
Cooper’s (pectineal) ligament
Arises from IO and transversus abdominus aponeuroses.
Conjoint tendon (falx inguinalis)
Preperitoneal space behind pubic symphysis. Site of laparoscopic hernia repairs.
Space of Retzius
Bordered by the inguinal ligament inferiorly, lateral border of the rectus sheath medially, and the inferior epigastric vessels superiolaterally.
Hesselbach’s triangle
Femoral hernias occur at what aspect of femoral canal
Medial
Inguinal hernias are more common on what side
Right
Location of indirect hernial sac relative to the cord
Anteromedial
Weakness in what fascia results to direct inguinal hernia
Transversalis fascia
Boundaries of the inguinal canal
Anterior: EO
Posterior: Transversalis fascia
Roof: IO, transversus abdominus
Floor: Inguinal ligament
Direct vs indirect hernia: reduce with supine position
Direct
High ligation with repair of inguinal floor. Involves approximation of transversalis fascia, conjoint tendon, and shelving edge of inguinal ligament.
Bassini
Avoid sutures in the pubic tubercle to minimize incidence of osteitis pubis.
Primary repair utilizing continuous running sutures in multiple layers.
Shouldice
Closure involves Cooper’s ligament. Used for both inguinal and femoral hernia repairs.
McVay
Tension-free repair that is used for direct and indirect hernias.
Lichtenstein
Avoid a mesh repair if infection is present.
“Plug and Patch” hernia repair
Stoppa repair
In hernia repair, staples must be avoided in this area lateral to femoral vessels and below iliopubic tract
trapezoid of doom
Structures in the trapezoid of doom
Lateral cutaneous, femoral branch of genitofemoral, and femoral nerves
Most common early complication of hernial repair
Urinary retention
Loss of cremasteric reflex and sensation to ipsilateral penis, scrotum, and medial thigh is an injury to
Ilioinguinal injury
Loss of sensation to the lower abdominal wall and inguinal region is an injury to
Iliohypogastric injury
Loss of sensation to the upper lateral thigh or loss of scrotal sensation and cremasteric motor function is injury to
Genitofemoral injury
Inguinal vs femoral hernia: greater incidence of incarceration and strangulation due to narrow neck.
Femoral
Repair for femoral hernia
McVay
The most commonly injured nerve during hernia repair.
ilioinguinal nerve
Superior to the cord
Umbilical hernia arises from facial defect in
Linea alba
Repair of small, childhood umbilical hernias (
4
Hernia through the linea semilunaris, particularly where the line of Douglas intersects the linea semilunaris.
Spigelian
Hernia through the inferior lumbar triangle (boundaries: posterior edge of the EO, latissimus dorsi, and iliac crest).
Petit’s
Hernia through the superior lumbar triangle (boundaries: 12th rib, serratus, IO, quadratus lumborum, and erector spinae).
Grynfeltt’s
Midline hernia through muscular aponeuroses that form the linea alba, in an area extending from xiphoid to umbilicus.
Epigastric
Hernia through the obturator foramen in pelvis; lie anteromedial to obturator nerve and vessels; most common in elderly women.
Obturator
Howship-Romberg sign
Hernia involving one wall of bowel. Can cause ischemia and strangulation, leading to perforation without associated obstruction.
Richter’s
Hernia involving a Meckel’s diverticulum.
Littre’s
Combination of indirect and direct inguinal hernias that straddle the inferior epigastric vessels.
Pantaloon
Sliding indirect hernia involves what organs?
Ovary, fallopian tube, cecum, sigmoid colon, bladder
During a McVay repair, bleeding is encountered. What is a possible source?
Aberrant obturator artery
An 80 year old has a medial thigh pain with leg abduction, internal rotation, or extension. Diagnosis?
Obturator hernia
Operative procedure
A 45 year old man has a dull groin ache and painful ejaculation after an inguinal hernia repair. What therapy will cure his symptoms?
Vasectomy
Dysejaculation syndrome (partial obstruction of the vas deferens
