Surgical technique & technology Flashcards
How do you differentiate between a direct and indirect hernia
Direct-within Hasselbach’s triangle/ medial to inferior epigastric vessels
Indriect-outside Hasselbach’s triangle/ lateral to inferior epigastric vessels
On examination, how do you differentiate between a direct and indirect hernia
Pressure over deep inguinal ring and ask patient to cough
-if hernia PRODUCED = DIRECT
-if hernia NOT PRODUCED = INDIRECT
What are the borders of Hasselbach’s triangle
Medial- rectus abdominis
Lateral- inferior epigastric vessels
Inferior- inguinal ligament
Indications for open hernia repair
First time hernia repair
Unilateral hernia
Indications for laparoscopic hernia repair
Recurrent hernia
bilateral hernia
Indications for emergency hernia repair
Neonatal (high risk of strangulation)
Strangulated hernia
incarcerated hernia
femoral hernia
Types of hernia repair
Bassini- suture transversalis fascia + conjoint tendon to inguinal ligament (NO mesh) HIGH recurrence
Shouldice repair- 4 layer repair and fascia sutured to inguinal ligament
Lichensteins repair- with mesh
What are the borders of the inguinal canal
M: transversus abdominis + internal oblique muscles
A: External oblique Aponeurosis
L: Inguinal + lacunar ligament
T: Conjoint tendon + transversalis fascia
remember MALT!!
Contents of the inguinal canal
M+F:
-Ilioinguinal nerve + Genital branch of genitofemoral nerve
M:
spermatic cord
F:
round ligament of uterus
What is the rule of 3’s in relation to the spermatic cord?
3 fascia layers
3 arteries
3 nerves
3 other structures
What are the structures that make up the spermatic cord
3 fascia= external, cremasteric, internal spermatic fascia
3 arteries= testicular, cremasteric, artery of vas deferens
3 nerves= ilioinguinal, genital branch of GF and sympathetic + visceral afferent nerves
3 other= vas deferens, pampiniform peluxus, testicular lymphatics
Which sutures are absorbable
vicryl
monocryl
PDS
Which sutures are non-absorbable
nylon
prolene
silk
ethibond
(PENS!)
Which sutures are monofilament vs braided
mono:
-PDS
-Prolene
-monocryl
-nylon
braided:
-vicryl
-silk
-ethibond
-
H.pylori is a gram _____ organism
NEGATIVE
What enzyme produced by H.pylori is detected by the CLO test
Urease
What reaction does urease act on in the stomach
urea to ammonia
How does the presence of H pylori cause gastritis
Urea converted to ammonia by urease
Ammonia acts on antral G cells to produce gastrin
Gastrin increases acidity and damages gastric epithelium
Gastritis and ulcers
What are the 3 criteria needed for an anastomosis to heal
-good blood supply
-minimal tension
-mucosal apposition
what type of suture is best for vascular anastomosis
monofilament
non-absorbable
small size (6/0)
eg: prolene
what shape needle is best for vascular anastomosis
round bodied
what is neo-intimal hyperplasia
when vascular smooth muscle cells migrate to and proliferate to areas of the tunica intima post-intervention thus causing thickening of the wall of the blood vessel and blockage
