SRGR RCL HRN Flashcards
What is it?
Hernia within the floor of Hesselbach’s triangle, that is, the hernia sac does not
traverse the internal r
Direct inguinal hernia
What is the cause of direct inguinal hernia?
Acquired defect from mechanical breakdown over the years
What nerve runs with the spermatic cord in the inguinal canal?
Ilioinguinal nerve
Cause of indirect inguinal hernia
PPV
Incidence of direct inguinal hernia
1% of men
Incidence of indirect inguinal hernia
5% of all men
most common inguinal hernia
indirect inguinal hernia
How is an inguinal hernia diagnosed?
mainly on hx and pe
What is the risk of strangulation?
a. higher with indirect hernia than femoral hernia
b. highest in femoral hernias
c. higher in direct than indirect hernia
d. NOTA
Higher with indirect than direct inguinal hernia, but highest in femoral hernias
Sutures approximate reflection of inguinal ligament (Poupart’s) to the transversus abdominis aponeurosis/conjoint tendon
a. Bassini
b. McVay
c. Lechenstein
d. plug and patch
A
Cooper’s ligament sutured to transversus abdominis aponeurosis/conjoint tendon a. Bassini b. McVay c. Lechenstein d. plug and patch
B
“Tension-free repair” using mesh
Lichtenstein
Placing a plug of mesh in hernia defect and then overlaying a patch of mesh
over inguinal floor (requires few if any sutures in mesh!)
plug and patch
Ligation and transection of indirect hernia sac without repair of inguinal floor
(used only in children)
High ligation
What are the indications for laparoscopic inguinal hernia repair?
- Bilateral inguinal hernias
- Recurring hernia
- Need to resume full activity as soon as possible
What is the first identifiable subcutaneous named layer?
Scarpa’s fascia (thin in adults)
What is the name of the subcutaneous vein that is ligated?
Superficial epigastric vein
What happens if you cut the ilioinguinal nerve?
Numbness of inner thigh or lateral scrotum; usually goes away in 6 months
From what abdominal muscle layer is the cremaster muscle
derived?
Internal oblique muscle
From what abdominal muscle layer is the inguinal ligament (a.k.a.
“Poupart’s ligament”) derived?
External oblique muscle aponeurosis
To what does the inguinal (Poupart’s) ligament attach?
Anterior-superior iliac spine to the pubic tubercle
Which nerve travels on the spermatic cord?
Ilioinguinal nerve
Why do some surgeons deliberately cut the ilioinguinal nerve?
remove the risk of
entrapment and postoperative pain
What is the hernia sac made of?
Peritoneum (direct) or a patent processus vaginalis (indirect)
What attaches the testicle to the scrotum?
Gubernaculum
What is the most common organ in an inguinal hernia sac in men?
Small intestine
What is the most common organ in an inguinal hernia sac in
women?
Ovary/fallopian tube
What lies in the inguinal canal in females instead of the VAS?
Round ligament
Where in the inguinal canal does the hernia sac lie in relation to the
other structures?
Anteromedially
Preperitoneal fat on the cord structures (pushed in by the hernia sac); not a real
lipoma; remove surgically, if feasible
cord lipoma
What is a small outpouching of testicular tissue off the testicle?
Testicular appendage
What nerve is found on top of the spermatic cord?
Ilioinguinal nerve
What nerve travels within the spermatic cord?
Genital branch of the genitofemoral nerve
What are the borders of Hesselbach’s triangle?
- Epigastric vessels
- Inguinal ligament
- Lateral border of the rectus
What type of hernia goes through Hesselbach’s triangle?
Direct hernia due to a weak abdominal floor
What is a “relaxing incision”?
Incision(s) in the rectus sheath to relax the conjoint tendon so that it can be
approximated to the reflection of the inguinal ligament without tension
Aponeurotic attachments of the of the internal oblique and
transversus abdominis to the pubic tubercle
conjoint tendon
