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Appendix > Hernias > Flashcards

Hernias Flashcards

1
Q

Approx. 75% of abdominal wall hernias occur where?

A

groin

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2
Q

Lifetime risk of inguinal hernias in men vs women?

A

men 27% women 3%

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3
Q

Most common subtype of groin hernia in men and women?

A

indirect inguinal hernia

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4
Q

Most common hernia in women?

A

indirect inguinal hernia

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5
Q

70% of femoral hernia repairs reported in women, however inguinal hernias are;

A

5x more common

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6
Q

The incidence of inguinal hernias has a bimodal age distribution;

A

before 1st year of age >40

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7
Q

The deep internal inguinal ring is a defect in what?

A

tranversalis fascia

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8
Q

The superficial external inguinal ring is a defect in what?

A

external oblique aponeurosis

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9
Q

This is the point at which the spermatic cord crosses the external oblique aponeuoosis;

A

superficial external inguinal ring

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10
Q

What are the boundaries of the inguinal canal?

A

A–> EO aponeurosis P–> tranversalis fascia, TO S–> IO I–> Inguinal (Poupart’s) ligament

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11
Q

Contents of the spermatic cord?

A

vas deferens testicular A ductus deferens A cremasteric A pampiniform plexus genital branch of genitofemoral N PSNS/SNS nerves lymphatics

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12
Q

What is the lacunar ligament?

A

triangular fanning of inguinal ligament as it joins pubic tubercle

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13
Q

What is Cooper’s (pectineal) ligament?

A

lateral portion of lacunar ligament that’s fused to periosteum of pubic tubercle

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14
Q

What two muscles make up the conjoint tendon?

A

IO + TA aponeurosis (they insert on pubic tubercle)

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15
Q

What’s an indirect hernia?

A

protrusion lateral to inferior epigastric vessels through deep inguinal ring

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16
Q

What’s a direct inguinal hernia?

A

protrude medial to inferior epigastric vessels within Hasselbach’s triangle

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17
Q

What are borders of Hasselbachs triangle?

A

inguinal ligament inferiorly

lateral edges of rectus sheath medially

inferior epigastric vessels superolaterally

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18
Q

Femoral hernias protrude thru the femoral ring, what are the borders?

A

iliopubic tract and inguinal ligament anteriorly

Cooper’s ligament posteriorly

lacunar ligament medially

femoral vein laterally

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19
Q

This classifies hernias based on location, size and type:

A

Nyhus classification

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20
Q

Inferior epigastric artery supplies what m?

A

rectus abdominus

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21
Q

Inferior epigastrics are derived from?

A

external iliac artery

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22
Q

Inferior epigastric vessels anastomose with what?

A

superior epigastric vessels which come off the internal mammary A

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23
Q

What 4 nerves are of interest during hernia repairs?

A

ilioinguinal N

iliohypogastric N

lateral femoral cutaneous N

genitofemoral N

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24
Q

What’s the course of the ilioinguinal nerve?

A

comes out medial to ASIS

enters inguinal canal

exits thru superifical inguinal ring

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25
Q

What does ilioinguinal nerve supply?

A

skin of upper/medial thigh

base of penis & upper scrotum

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26
Q

What does ilioinguinal nerve innervate in females?

A

mons pubis

labia majus

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27
Q

Course of iliohypogastric N?

A

comes off of T12-L1

course between IO and TA (supplies both)

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28
Q

This nerve arises from L1-L2, courses along the retroperitoneum and then pierces the psoas:

A

genitofemoral

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29
Q

Genital branch of genitofemoral nerve supplies what?

A

ipsilateral scrotum and cremaster M

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30
Q

Femoral branch of genitofemoral N supplies what?

A

skin of upper anterior thigh

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31
Q

Genital branch of genitofemoral N supplies what in females?

A

mons pubis

labia majus

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32
Q

This N passes inferior to inguinal ligament where it divides to supply the lateral thigh:

A

lateral femoral cutaneous N

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33
Q

What is the triangle of doom?

A

space seen in laparoscopic hernia repair

bordered medially by vas

bordered laterally by vessels of spermatic cord

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34
Q

What do we worry about with the triangle of doom?

A

external iliac vessels

deep circumflex iliac vein

femoral N

genital branch of genitofemoral N

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35
Q

What nerves do we find in the triangle of pain?

A

lateral femoral cutaneous

femoral branch of genitofemoral

femoral

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36
Q

Best characterized risk factor for development of inguinal hernias is?

A

weakness in abdominal wall muscles

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37
Q

Inguinal hernias can be congenital or acquires, most adults hernias are acquired, while in this population they tend to be congenital:

A

pediatric

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38
Q

Why do pre-term babies have a high incidence of congenital inguinal hernias?

A

failure of processus vaginalis to close

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39
Q

Does genetics play a role in development of inguinal hernias?

A

positive family hx associated with 8-fold lifetime incidence of inguinal hernias

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40
Q

How does COPD increase risk of direct inguinal hernias?

A

repeated episodes of increased intra-abdominal pressures

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41
Q

What role does collagen play in inguinal hernia development?

A

pts tend to have decreased ratios of type I to type III collagen

(type III collagen does not contribute to wound tensile strength as well as type I)

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42
Q

With a pt with suspected hernia, if they have change in bowel or bladder habits, what type of hernia do we suspect?

A

sliding hernia with a bowel or bladder component

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43
Q

On physical exam how do we examine pts for hernias?

A

ideally standing position

groin and scrotum exposed

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44
Q

Where do we palpate for femoral hernias?

A

below inguinal ligament

lateral to pubic tubercle

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45
Q

What’s a femoral pseudohernia?

A

if a thin pt has a prominent fat pad

erroneously think it’s a femoral hernia

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46
Q

Surgical treatment is definitive treatment for inguinal hernias, but what about asymptomatic hernia pts?

A

a non operative approach is safe for minimally symptomatic inguinal hernia pts

does not increase risk of developing hernia complications

complication rates between immediate and delayed tension free repairs ae the same

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47
Q

For femoral and symptomatic inguinal hernias, there is a higher complication risk, thus;

A

surgical repair performed earlier for these pts

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48
Q

Antibiotics before elective open surgical inguinal hernia repair?

A

no universal guidelines established for or against

however, routinely given peri-operatively

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49
Q

What do we term a hernia sac that fails to reduce?

A

incarceration

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50
Q

With respect to hernias, when we have compromise of intestinal contents, we are worried about;

A

strangulation

surgical emergency

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51
Q

Clinical signs of strangulation of hernia include what?

A

fever

leukocytosis

hemodynamic instability

(bulge is warm/tender with erythema or discoloration)

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52
Q

In open inguinal hernia repairs, when do we opt for tensions free tissue repairs vs prosthetic material ?

A

when there is contamination or strangulation

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53
Q

When do we use local anesthesia for an open inguinal hernia repair?

A

as a loco-regional ilio-inguinal nerve block

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54
Q

What’s your incision for an open approach?

A

2 figerbreadths infero-medial to ASIS

extended 6-8 cm medially

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55
Q

As we dissect the skin and subcutaneous tissue in an open inguinal hernia repair, what layer do we dissect before seeing the external oblique?

A

scarpa’s fascia

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56
Q

Describe steps of an open inguinal hernia approach:

A

incision made infero medially to ASIS, extended medially

dissection begins on skin, down to subQ fat, thru camper’s, scarpa’s to expose external oblique apo

incision made on external oblique apo

scissors used to excise the aponeurosis, opening the external ring

flaps of external oblique elevated

internal oblique fibers bluntly dissected off EO

shelving edge of inguinal ligament seen after dissecting inferior flap

iliohypogastric and ilioinguinal nerves identified

pubic tubercle identified, cord structures elevated with a penrose

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57
Q

For an indirect hernia, where do we usually find the hernia in relation to the spermatic cord?

A

anterolateral

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58
Q

How do we identify the hernia sac during an open repair?

A

at the leading edge of the sac, the two layers of peritoenum will fold upon themselves, and reveal a white edge

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59
Q

During open hernia repair, injury to what cord structure can result in testicular atrophy and ischemia?

A

pampiniphom venous plexus

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60
Q

Where do we find the genital branch of the genitofemoral nerve in the cord structures?

A

on the infero-lateral surface of the cord

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61
Q

Most common synthetic prosthesis used in hernia repairs?

A

polypropolene & polyester

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62
Q

Describe polypropolene and polyester meshes;

A

permanent & hydrophobic

promote local inflammatory response

cell infiltration and scarring

contraction in size

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63
Q

Difference in using lightweight mesh vs heavy weight mesh in hernia repair?

A

less pain with lightweight mesh

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64
Q

When do we use biologic meshes?

A

contaminated cases

high infection risk

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65
Q

Xenograft vs allograft biological mesh material for hernia repairs?

A

xenografts assc. with lower recurrence rate

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66
Q

The most common complications of inguinal hernia repairs?

A

bleeding

seroma

wound infection

urinary retention

ileus

injury to nearby structures

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67
Q

Common medical issues associated with hernia recurrence?

A

malnutrition

immunosuppression

DM

steroid use

smoking

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68
Q

What are some technical causes of hernia recurrence?

A

improper mesh size

tissue infection

ischemia

tension in the reconstruction

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69
Q

When a hernia recurrence has occured, and needs re-operation, how do we proceed?

A

through a virgin plane

after an initial anterior approach, a posterior lap approach may be more suitable and vice versa

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70
Q

What are the three different types of pain commonly seen after hernia repair?

A

somatic (nociceptive)*

neuropathic

visceral

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71
Q

How do we treat somatic post-hernia pain?

A

usually a result of anatomic trauma and inflammation

reproduced with abd. muscle contraction

Tx–> rest, NSAIDs, reassurance

resolves spontaneously in most cases

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72
Q

What causes neuropathic post-op hernia pain?

A

direct nerve damage or entrapment

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73
Q

Describe visceral post-op hernia pain;

A

pain via afferent autonomic fibers

poorly localized

can occur after ejaculation (due to SNS plexus injury)

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74
Q

How do we treat chronic inguinoydnia refractory to medical therapy?

A

triple neuro-ectomy of ilioinguinal, iliohypogastric, genitofermoral nerves

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75
Q

What two nerves are at greatest risk of injury durion open anterior repairs?

A

ilioinguinal

iliohypogastric

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76
Q

What two nerves are at greatest risk of injury in the posterior laparoscopic approach?

A

lateral femoral cutaneous

genitoferomal

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77
Q

What’s meralgia paresthetica?

A

entrapment of lateral femoral cutaneous nerve

paresthesias of lateral thigh

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78
Q

What is osteitis pubis?

A

inflammation of pubic symphysis

pubc symphysis pain with thigh adduction

avoid the pubic periosteum when tacking mesh

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79
Q

How long does it take for osteitis pubis to resolve regardless of treatment?

A

at least 6 months

80
Q

Ischemic orchitis usually caused by injury to what cord structure?

A

pampiniform venous plexus

81
Q

When do we see ischemic orchitis in hernia repairs?

A

damage to pampiniform plexus

within 1 week of repair (enlarged, indurated, painful testes)

82
Q

Risk of ischemic orchitis with primary hernia repairs?

A

<1 %

83
Q

In ischemic orchitis, US is used to demonstrate testicular blood flow, when do we perform orchiectomy?

A

incase of necrosis

84
Q

Tx for ischemic orchitis?

A

reassurance

NSAIDs

comfort measures

85
Q

Analog of the spermatic cord in females?

A

round ligament of uterus

86
Q

Does injury to artery of round ligament in females during hernia repair cause any problems?

A

no

87
Q

Most common cause of urinary retention after hernia repair is?

A

general anesthesia

88
Q

This type of hernia repair is associated with higher rates of ileus:

A

laparoscopic

89
Q

What organs are at risk of injury during laparoscopic hernia repairs?

A

small bowel

colon

bladder

90
Q

If a bladder injury is made during hernia repair how is it addressed?

A

cystostomy is repaired in several layers

Foley for 1-2 weeks

cystogram before Foley removed

91
Q

Severe vascular injuries during hernia repair occur due to damage of what vessels?

A

iliac or femoral vessels

(either by sutures in anterior approach or trocar and direct dissection in laparoscopic approach)

92
Q

Most common injured vessels in laparoscopic approach include?

A

inferior epigastrics

external iliacs

93
Q

If the inferior epigastrics are injured during hernia repair what do we do?

A

can be ligated

94
Q

During vascular hernia repair injuries, why is bleeding not apparent until pneumoperitoneum released?

A

if the tissue pressure exerted by pneumoperitoneum is greater than the injured vessel’s hydrostatic intraluminal pressure, wont’ be apparent until pneumoperitoneum is released

95
Q

Why is the presentation of an inferior epigastric vein injury often delayed?

A

pneumoperitoneum needs to be released

it usually exerts a greater pressure on vessel hydrostatic pressure

96
Q

Injury to the inferior epigastric vein can result in what?

A

a rectus sheath hematoma

97
Q

What is a seroma?

A

loculated fluid collection

commonly seen within 1 week of synthetic repairs

98
Q

How do we treat seromas?

A

reassurance and warm compresses

99
Q

To avoid secondary infection of seromas, we?

A

avoid aspirating them unless they cause discomfort or restrict activity

100
Q

Most common tissue repair hernia technique performed?

A

shouldice

101
Q

Recurrence rate of shouldice repair is?

A

1% in experienced hands

102
Q

Compared to open tissue based repairs, mesh repair is associated with what?

A

lower recurrence rate

shorter hospital stay

103
Q

Abdominal wall hernais commonly occur at sites where?

A

the aponeurosis and fascia are not covered by striated muscle

104
Q

Common hernia sites include? (sites where the aponeurosis and fascia are not covered by fascia)

A

inguinal, femoral, umbilical areas, linea alba, semi-lunar lines, sites of prior incisions

105
Q

What’s a reducible hernia?

A

contents can be replaced within surrounding musculature

106
Q

When a hernia cannot be reduced, it’s?

A

incarcerated

107
Q

This type of hernia has a compromised blood supply to its contents;

A

strangulated hernia

108
Q

With this type of hernia, part of bowel wall becomes trapped, usually anti-mesenteric side of small bowel, with intact intestinal lumen;

A

Richter’s

109
Q

Can you have strangulation of hernia contents without obstruction?

A

yes, in a richter’s hernia

small bowel wall trapped in defect, usually anti-mesenteric side, with patent small bowel lumen

110
Q

Internal vs external hernia?

A

ex–> protrusion through all layers of abdominal wall

in–> protrustion through a defect in the peritoneal cavity

111
Q

Inguinal hernias classified as direct vs indirect, what’s the path of an indirect inguinal hernia?

A

sac passes from internal ring to external ring to the scrotum

112
Q

Whats the path of a direct inguinal hernia?

A

protrudes outward and forward

medial to internal ring and inferior epigastrics

113
Q

What’s a pantaloon hernia?

A

hernia with both direct and indirect components

114
Q

75% of hernias occur in inguinal region, and 2/3 are?

A

indirect

115
Q

Femoral hernias make up what % of all groin hernias?

A

3%

116
Q

Regardless of gender, what’s the most common type of hernia?

A

indirect inguinal hernia

117
Q

Indirect inguinal and femoral hernias most commonly occur on what side?

A

right side

due to slower descent of right testicle and delayed closure of processus vaginalis during development

118
Q

Why are femoral hernias more common on the right side?

A

due to tamponading effect of sigmoid colon on left femoral canal

119
Q

Most common serious complication of hernias?

A

strangulation

happens in 1-3% of hernias

120
Q

Why is it recommended that all femoral hernias be repaired at time of discovery?

A

have highest rates of strangulation at 15-20%

121
Q

Most superficial of lateral abdominal wall muscles?

A

external oblique

oriented inferiorally & medially

122
Q

The inguinal ligament (Poupart’s) is the inferior aspect of what?

A

external oblique aponeurosis

123
Q

What is the lacunar ligament?

A

medial fanning of inguinal ligament (Pouparts) which inserts into pubis

124
Q

Spermatic cord exits through the external inguinal ring which is an opening in what?

A

external oblique aponeurosis

125
Q

Middle layer of abdominal wall encases what muscle?

A

internal oblique m

126
Q

This muscle is the superior border of inguinal canal;

A

internal oblique m

127
Q

What makes up the conjoint tendor?

A

internal oblique muscle fibers + tranverse abdominis aponeurosis

128
Q

Conjoint tendon is present in what % of pts?

A

5-10 %

129
Q

The internal oblique muscle gives rise to what testicular structure?

A

cremasteric fibers

130
Q

What’s the pectineal (Coopers) ligament?

A

formed by the periosteum and aponeurotic tissues along superior pubic ramus

131
Q

Why is cooper’s ligament an important landmark?

A

important achoring structure

132
Q

What does the inguinal canal contain in men vs women:

A

m–>spermatic cord

w–> round ligament of uterus

133
Q

What are the four borders of the inguinal canal?

A

anteriorly–> external o. aponeurosis

posteriorly–> tranverse abdominis m./tranversalis fascia

roof–> internal o. m. & tranversus abd. m

floor–> inguinal ligament & lacunar

134
Q

Borders of Hasselbach’s triangle?

A

medial border–> rectus sheath

supero-lateral border–> inferior epigastrics

inferior border–> inguinal ligament

135
Q

What type of hernia’s occur within Hasselbach’s triangle?

A

DIRECT

(indirect occur lateral to it)

136
Q

The ilioinguinal nerves lies where in the spermatic cord?

A

anterior

137
Q

Genital branch of genitofemoral nerve innervates what muscle?

A

cremaster m

lateral side of scrotum and labia

138
Q

The genitofemoral nerve divides into the two branches where?

A

anterior surface of psoas

139
Q

Inferior epigastric artery and vein are branches off what?

A

external iliacs

140
Q

The inferior epigastric vessels course medial to what?

A

internal inguinal ring

141
Q

Borders of femoral canal?

A

medially–> lacunar ligament

laterally–> femoral vein

anteriorly–> inguinal ligament

posteriorly–> pectineal ligament

142
Q

Femoral hernias tend to occur medial to what vessels?

A

femoral vessels

143
Q

What are the technical aspects of an open inguinal hernia repair?

A

curvilinear incision made slightly above inguinal ligament halfway between ASIS & pubic tubercle

carry dissection thru subQ tissues and scarpa’s

external oblique fascia identified

external oblique fascia incised at superficial inguinal ring

nerves identified

spermatic cord mobilized at pubic tubercle

cremasteric fibers separated from cord

hernia sac dissected off cord structures and dissected at level of internal inguinal ring

sac opened and examined if large

144
Q

In an indrect hernia, the hernia sac is found where?

A

anterior superior to cord structure

145
Q

What is a sliding hernia?

A

hernia containing piece of organ, usually colon or bladder

146
Q

When do we do a tissue repair for henria repairs?

A

in strangulated hernias where bowel resection is necessary and mesh prostheses are contraindicated

147
Q

What are the different types of henria tissue repairs?

A

McVay

Shouldice

Bassini

148
Q

Shouldice repair?

A

multilayer imbricated repair of posterior wall of inguinal canal with running suture

149
Q

This tissue based repair reconstructs the posterior wall of inguinal canal by superimposing running suture lines progressing from more deep to superficial;

A

Shouldice repair

150
Q

Shouldice repair?

A

reconstructing posterior wall in multiple layers, deep to superficial, continuous running sutures

tranversus abdominis aponeurotic arch secured to iliopubic tract

IO and TA muscles sutured to inguinal ligament

151
Q

What is a Bassini repair?

A

suturing tranverse abdominus and internal oblique or conjoint tendon to the inguinal ligament

152
Q

With this tissue based repair, a relaxing incision usually needed;

A

McVay

153
Q

McVay repair is particularly suited for what type of repair?

A

strangulated femoral hernias

154
Q

Lichtenstein repair?

A

tension-free hernia repair using mesh

155
Q

In Lichtenstein’s repair, where do you suture the mesh?

A

monofilament, non-absorbable suture used to secure mesh at pubic tubercle

medially–> aponeurotic pubic bone tissue

superiorly–> tranverse abdominus or conjoint tendon

inferiorly–>iliopubic tract or shelving edge of inguinal ligament

the tails created by suture slit are sutured together around spermatic cord forming new internal ring

156
Q

Gilbert’s repair?

A

adapting principles of tension free repair + cone shaped plug of polyprop mesh

157
Q

Difference between TEP and TAPP?

A

sequence of gaining access to the preperitoneal space

TEP–> dissection begins in preperitoneal space using baloon dissector

TAPP–>preperitoneal space is accessed after initially entering the preperitoneal cavity

158
Q

Contraindications for laparoscopic hernia repair?

A

no absolute contraindications except pts inability to tolerate general anesthesia

159
Q

How do you perform a TEP?

A

infraumbilical incision made

anterior rectus sheath incised, space created beneath rectus

dissecting balloon inserted posterior to rectus, advanced to pubic symphysis, then inflated

space insufflated and additional trocars placed

160
Q

How to do a TAPP?

A

infraumbilical incision is made to gain access to peritoneal cavity directly

2- 5 mm ports placed lateral to inferior epigastrics at level of umbilicus

peritoneal flap created on anterior abdominal wall, extending from median umbilical wall to ASIS

161
Q

Borders of femoral canal?

A

ilipubic tract superior

cooper’s ligament inferiorly

femoral vein laterally

lacunar ligament medially

162
Q

Recurrence of femoral hernia after repair?

A

2%

(recurrent femoral hernias have a recurrence of 10%)

163
Q

What’s a sliding hernia?

A

when an internal organ comprises a portion of the wall of hernia sac

164
Q

Most common organs involved in sliding hernia?

A

colon vs bladder

165
Q

Risk of surgical site infection after open inguinal hernia repair?

A

1-2%

166
Q

Linea alba is stretched resulting in bulging at medial edges of rectus muscles;

A

rectus diastasis

167
Q

Whats the arcuate line?

A

3-6 cm below umbilicus

point at which posterior rectus sheath is absent

168
Q

What happens above vs below the arcuate line?

A

above arcuate line; external oblique, internal oblique and tranversus abdominus all contribute to anterior and posterior rectus sheath equally

below arcuate line; aponeurosis of external, internal, tranversus abdominus muscles all pass anterior to rectus muscle, posterior rectus fused to tranversalis fascia only

169
Q

Superior and inferior epigastrics anastomose where?

A

near umbilicus

170
Q

In lateral abdominal wall anatomy, the neurovascular bundle is found between what muscle layers?

A

between tranverse abdominis and internal oblique

171
Q

More than 50% of obturator hernias present with what?

A

small bowel obstruction

172
Q

Whats the treatment for a pt who presents with obturator hernia and small bowel obstruction?

A

urgen surgery (lap vs open) given high risk of ischemia

173
Q

This is the only open non-mesh repair that be used for repair of either inguinal or femoral hernias:

A

McVay

174
Q

For laparoscopic hernia repairs with intraperitoneal placement of mesh, how much do we have mesh overlap?

A

3-5 cm overlap between fascia and abdominal wall

175
Q

What types of meshes can be used in contaminated fields?

A

vicyrl mesh–> absorbable, thus no prosthetic material long-term

biologic mesh–> acellular collagen matrix that promotes neovascularization and collagen deposition

176
Q

Difference between polypropolene mesh and PTFE?

A

polypropolene mesh—> incorporated into native tissue

PTFE–> does not incorporate into tissues

177
Q

In women of childbearing age, who are pregnant, who need a hernia repair, what do we do?

A

usually wait post-partum

most will not need any surgical intervention

do not use mesh in women of child-bearing age because the mesh cannot stretch to accomodate gravid uterus

178
Q

Course of genitofemoral nerve?

A

starts from lumbar plexus

pierces psoas then divides into genital/femoral branches

genital branch exits via deep inguinal ring with spermatic cord

179
Q

Where do Spigelian hernias occur?

A

between rectus abdominus medially and semilunar line laterally thru traversus abominus aponeurosis

180
Q

What’s the Howship-Romberg sing?

A

adduction and medial rotation of the thigh which helps identify an obturator hernia

181
Q

What’s the optimal way to repair a parastomal hernia?

A

covert the parastomal hernia to an incisional hernia by reversing ostomy

182
Q

Primary repair of incisional hernias can be performed when the defect is how big?

A

less than 2-3 cm

defects >2-3 cm require mesh (b/c of high recurrence rate if done primarily)

183
Q

This type of mesh is hydrophobic and macroporous and allows for ingrowth of native fibroblasts and incorporation into surround fascia;

A

polypropolene mesh

184
Q

WHy do we not place polypropolene meshes intraperitoneal directly apposed to the bowel?

A

high rates of enterocutaneous fistulae formation

185
Q

This is a hydrophobic, heavyweight, macroporous mesh;

A

polyester mesh

186
Q

What is PTFE mesh?

A

single sheet mesh

visceral side is microporous

abdominal wall side is macroporous (promotes tissue growth)

impermeable to fluids

some tissue ingrowth seen

PTFE is not incorporated into native tisues

when infected, PTFE needs to be removed

187
Q

What’s a composite mesh?

A

combines polypropolene + PTFE

PTFE serves as a protective barrier against bowel

polypropolene faces superficially and gets incorporated into fascial tissue

188
Q

What are biologic meshes?

A

acellular collagen matrices

provide a matrix for neovascularization and native collagen deposition

advantageous in infected/contaminated cases

189
Q

What is the onlay mesh repair technique for ventral hernia repairs?

A

primary closure of fascial defect

mesh placed over anterior rectus fascia

advntage; mesh placed outside abd cavity, no interaction with abdominal viscera

disadvantage; have to dissec thru subQ, seroma formation, superficial location of mesh if you get insional infection

190
Q

What is an interposition synthetic repair or inlay mesh?

A

mesh secured to fascial edges without overlap

has high rates of recurrence, due to mesh pulling away from fascial edges bc of increased intra-abdominal pressure

191
Q

Where do most Spigelian hernias occur?

A

lateral rectus and semilunar line

at or below arcuate line (absence of a posterior rectus fascia contributes to this weakness)

192
Q

Pain in antero-medial thigh relieved by thigh flexion?

A

howship romberg sign–> obturator hernia

193
Q

Almost 50% of pts with that type of hernia present with partial or complete SBO?

A

obturator

194
Q

What’s Grynfeldt lumbar hernia?

A

protrusion thru superior lumbar trinagle;

12th rib, paraspinal muscles, IO muscle

195
Q

What’s Petit’s triangle?

A

inferior lumbar triangle;

iliac crest

lattissimus dorsi

EO muscle

196
Q

How do we repair lumbar hernias?

A

usually with mesh

bony landmarks make it difficult to repair primarily with sutures

Appendix (39 decks)

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