Hernias Review Flashcards
Site of indirect inguinal hernia
- lateral to inferior epigastric vessels
- superior to inguinal ligament
site of a direct inguinal hernia
- medial to inferior epigastric vessels
- superior to inguinal ligament
Site of a femoral hernia
- medial to external iliacs
- inferior to inguinal ligament
- within femoral canal
how do you manage a parastomal hernia?
- if asx you can watch and wait
- if sx then perform a sugarbaker or keyhole laparoscopic repair
male patient presents with a painless scrotal mass, what is the next step?
translumination of the mass to differentiate between inguinal hernia and hydrocele
Most appropriate treatment for patient with ventral hernia in need of PD catheter
repair hernia during same procedure as placement of PD catheter
how do you treat diastasis recti?
- initially its weight loss
- if that fails than open or laparoscopic plication of the rectus sheath
patient with several years of pain after hernia repair uncontrolled by oral pain medications…what can you try?
- injection of local anesthetic
- if that fails then triple neurectomy with mesh removal
what forms the conjoint tendon?
internal oblique and transversus abdominis aponeurosis
what is Cooper’s ligament
- AKA: pectineal ligament
- an extension of the lacunar ligament
what is the pectineal ligament?
- AKA: Cooper’s ligament
- extension of the lacunar ligament
What is the lacunar ligament?
- formed form aponeurosis of the external oblique
- connects the inguinal ligament (Poupart’s ligament) to the pectineal ligament (cooper’s ligament)
What is the only structure that can be cut in a femoral hernia case to help release the contents of the hernia?
- lacunar ligament at the pubic tubercle (where it inserts)
McVay repair
use and describe it
- for femoral hernia repair
- suturing conjoint tendon to cooper’s ligament
Tenets for hernia repair in patient with ascites?
- broad spectrum Antibiotics
- resuscitation with 25% albumin for lost ascitic fluid
- aggressive control of ascites pre and post-op
Ilioinguinal nerve function?
sensation to:
- medial thigh
- scrotum and root of penis in men
- part of labium and root of clitoris
Bassini repair of an inguinal hernia?
suture the conjoined tendon and transversals fascia to the inguinal ligament (ligament of Poupart) posterior to the spermatic cord. usually requires a relaxing incision.
boundaries of a femoral hernia
- iliopubictract anteriorly (inguinal ligament/Poupart ligament
- Lacunar Ligament medially
- Cooper’s (pectineal) ligament posteriorly
- femoral vein laterally
borders of inguinal canal
superior - internal oblique, transverse abdominal
anterior - exterior oblique
inferior - inguinal ligament
posterior - transversalis fascia
common nerve injuries during open inguinal hernia repair
- ilioinguinal
- genital branch of genitofemoral
- iliohypogastric
common nerve injuries during laparoscopic inguinal hernia repair
- genitofemoral
- lateral femoral cutaneous nerve
what structure forms the floor of the inguinal canal
transversalis fascia
hernia noted to be a secondary to a weakness in the transversalis fascia, what kind of hernia is it?
most likely a direct inguinal hernia, should be medial to inferior epigastric artery
borders of Hasselbach triangle
- medial is rectus sheath
- inferior is inguinal ligament
- lateral is inferior epigastrics
what kind of hernia passes through Hasselbach’s triangle
- direct inguinal hernias
borders of triangle of doom
this is inferior to inguinal ligament (iliopubic tract laparoscopically)
- medial is vas deferens
- lateral is spermatic vessels
what lies within the triangle of doom in laparoscopic hernia repairs
external iliacs
borders of the triangle of pain
superior and lateral is iliopubic tract
medial are the spermatic vessels
what lies within the triangle of pain in laparoscopic hernia repairs
- lateral cutaneous femoral nerve
- femoral branch of genitofemoral nerve
what is the path of the ilioinguinal nerve?
anterior to the spermatic cord
what is the path of the iliohypogastric nerve?
- anterior to internal oblique muscle/aponeurosis
- medial and superior to internal ring
path of the genital branch of the genitogemoral nerve?
within the spermatic cord
petit hernia
- though the lumbar triangle
- anterior border is external oblique, posterior border is latissimus dorsi, inferior border is iliac crest
Grynfelt hernia
- hernia through superior lumbar triangle
- bordered by quadratus lumborum, internal oblique and 12th rib
