Hernias Review

Question 1

Site of indirect inguinal hernia

Answer 1

• lateral to inferior epigastric vessels

- superior to inguinal ligament

Question 2

site of a direct inguinal hernia

Answer 2

• medial to inferior epigastric vessels

- superior to inguinal ligament

Question 3

Site of a femoral hernia

Answer 3

• medial to external iliacs
• inferior to inguinal ligament
• within femoral canal

Question 4

how do you manage a parastomal hernia?

Answer 4

• if asx you can watch and wait

- if sx then perform a sugarbaker or keyhole laparoscopic repair

Question 5

male patient presents with a painless scrotal mass, what is the next step?

Answer 5

translumination of the mass to differentiate between inguinal hernia and hydrocele

Question 6

Most appropriate treatment for patient with ventral hernia in need of PD catheter

Answer 6

repair hernia during same procedure as placement of PD catheter

Question 7

how do you treat diastasis recti?

Answer 7

• initially its weight loss

- if that fails than open or laparoscopic plication of the rectus sheath

Question 8

patient with several years of pain after hernia repair uncontrolled by oral pain medications…what can you try?

Answer 8

• injection of local anesthetic

- if that fails then triple neurectomy with mesh removal

Question 9

what forms the conjoint tendon?

Answer 9

internal oblique and transversus abdominis aponeurosis

Question 10

what is Cooper’s ligament

Answer 10

• AKA: pectineal ligament

- an extension of the lacunar ligament

Question 11

what is the pectineal ligament?

Answer 11

• AKA: Cooper’s ligament

- extension of the lacunar ligament

Question 12

What is the lacunar ligament?

Answer 12

• formed form aponeurosis of the external oblique

- connects the inguinal ligament (Poupart’s ligament) to the pectineal ligament (cooper’s ligament)

Question 13

What is the only structure that can be cut in a femoral hernia case to help release the contents of the hernia?

Answer 13

• lacunar ligament at the pubic tubercle (where it inserts)

Question 14

McVay repair

use and describe it

Answer 14

• for femoral hernia repair

- suturing conjoint tendon to cooper’s ligament

Question 15

Tenets for hernia repair in patient with ascites?

Answer 15

• broad spectrum Antibiotics
• resuscitation with 25% albumin for lost ascitic fluid
• aggressive control of ascites pre and post-op

Question 16

Ilioinguinal nerve function?

Answer 16

sensation to:

• medial thigh
• scrotum and root of penis in men
• part of labium and root of clitoris

Question 17

Bassini repair of an inguinal hernia?

Answer 17

suture the conjoined tendon and transversals fascia to the inguinal ligament (ligament of Poupart) posterior to the spermatic cord. usually requires a relaxing incision.

Question 18

boundaries of a femoral hernia

Answer 18

• iliopubictract anteriorly (inguinal ligament/Poupart ligament
• Lacunar Ligament medially
• Cooper’s (pectineal) ligament posteriorly
• femoral vein laterally

Question 19

borders of inguinal canal

Answer 19

superior - internal oblique, transverse abdominal
anterior - exterior oblique
inferior - inguinal ligament
posterior - transversalis fascia

Question 20

common nerve injuries during open inguinal hernia repair

Answer 20

• ilioinguinal
• genital branch of genitofemoral
• iliohypogastric

Question 21

common nerve injuries during laparoscopic inguinal hernia repair

Answer 21

• genitofemoral

- lateral femoral cutaneous nerve

Question 22

what structure forms the floor of the inguinal canal

Answer 22

transversalis fascia

Question 23

hernia noted to be a secondary to a weakness in the transversalis fascia, what kind of hernia is it?

Answer 23

most likely a direct inguinal hernia, should be medial to inferior epigastric artery

Question 24

borders of Hasselbach triangle

Answer 24

• medial is rectus sheath
• inferior is inguinal ligament
• lateral is inferior epigastrics

Question 25

what kind of hernia passes through Hasselbach’s triangle

Answer 25

• direct inguinal hernias

Question 26

borders of triangle of doom

Answer 26

this is inferior to inguinal ligament (iliopubic tract laparoscopically)

• medial is vas deferens
• lateral is spermatic vessels

Question 27

what lies within the triangle of doom in laparoscopic hernia repairs

Answer 27

external iliacs

Question 28

borders of the triangle of pain

Answer 28

superior and lateral is iliopubic tract

medial are the spermatic vessels

Question 29

what lies within the triangle of pain in laparoscopic hernia repairs

Answer 29

• lateral cutaneous femoral nerve

- femoral branch of genitofemoral nerve

Question 30

what is the path of the ilioinguinal nerve?

Answer 30

anterior to the spermatic cord

Question 31

what is the path of the iliohypogastric nerve?

Answer 31

• anterior to internal oblique muscle/aponeurosis

- medial and superior to internal ring

Question 32

path of the genital branch of the genitogemoral nerve?

Answer 32

within the spermatic cord

Question 33

petit hernia

Answer 33

• though the lumbar triangle

- anterior border is external oblique, posterior border is latissimus dorsi, inferior border is iliac crest

Question 34

Grynfelt hernia

Answer 34

• hernia through superior lumbar triangle

- bordered by quadratus lumborum, internal oblique and 12th rib