Inguinal Anatomy/Technique

Question 1

What are the two types of Inguinal Hernias?

Answer 1

Direct and Indirect

Question 2

Two reasons for weakness’s in the groin

Answer 2

Internal oblique and transverse abdominal don’t cover down to the inguinal ligament -direct hernia
Muscles do not tighten around spermatic cord- indirect hernia

Question 3

Indirect sac is made out of the

Answer 3

peritoneum

Question 4

Which tend to be larger? Indirect or Direct hernias?

Answer 4

Direct

Question 5

Location of Direct Hernia?

Answer 5

Medial to epigastric

Question 6

Location of Indirect hernia?

Answer 6

Lateral to epigastric

Question 7

Location of femoral hernia?

Answer 7

Just below inguinal ligament

Question 8

Lichtenstein Repair Technique

Answer 8

anterior approach to anterior repair

Question 9

Plug Repair Technique

Answer 9

anterior approach to anterior or posterior repair

Question 10

MK Technique

Answer 10

anterior approach and posterior repair

Question 11

3 Different Types of Open Repairs

Answer 11

Lichtenstein, Plug Repair and MK Repair

Question 12

2 Types of Laproscopic Repairs

Answer 12

TAPP and TEP

Question 13

TAPP stands for

Answer 13

Transabdominal prepirtoneal apprach

Question 14

TEP stands for

Answer 14

Totally Extra Peritoneal Approach

Question 15

TAPP Approach (steps)

Answer 15

approached via abdominal cavity
peritoneum is incised
hernia sac is dissected and reduced
mesh is placed to cover the inguinal area
peritoneum is re-approximated
gas removed from the abdomen

Question 16

TEP Approach (steps)

Answer 16

Balloon dissector used to separate peritoneum from the muscles and fascia of the abdominal wall
Hernia sac is opened and may be severed
Mesh is placed to cover defect area
CO2 removed from abdomen

Question 17

Triangle of Pain

Answer 17

Nerves - area of femoral branch

Question 18

Triangle of Doom

Answer 18

Blood supply (iliac vessels)

Question 19

Advantages of LAP

Answer 19

Minimally invasive
Minimal pain
quick recovery
good visibility for detecting other defects

Question 20

Disadvantages of LAP

Answer 20

general anesthesia
high costs
severity of complications high

Question 21

Classic Technique for Indirect Hernia

Answer 21

Grasp the whole plug and insert into defect

Suture outer cone to margins of defect

Question 22

Modified Technique Indirect Hernia

Answer 22

Grasp inner petals and place deep into defect allowing outer cone of plug to open in perperitoneal space
Suture inner petals to margins of defect

Question 23

What is the importance of fixating the peritoneum in a TAPP procedure

Answer 23

protects the bowel from growing into the mesh