The Surgical Review- Hernia

Question 1

What are the borders of the inguinal canal?

Answer 1

anterior: aponeurosis of the external oblique
posterior: transversalis fascia
superior: aponeurosis of the internal oblique
inferior: inguinal ligament

Question 2

what are the borders of the femoral hernia?

Answer 2

medial: lacunar ligament
lateral: common femoral vein
superior: inguinal ligament
inferior: cooper ligament

Question 3

what is the deep inguinal ring?

Answer 3

a defect in transversalis fascia approx halfway between the ASIS and the pubic tubercle
- spermatic cord and round ligament exit the abdominal cavity and enter the inguinal canal

Question 4

what is hesselbachs triangle?

Answer 4

• through which direct inguinal hernia protrudes
  1. Inferior epigastric artery laterally
  2. Inguinal ligament inferiorly
  3. Rectus sheath medially

Question 5

what is an indirect hernia?

Answer 5

protrudes LATERAL to the inferior epigastric artery and anteromedial to the spermatic cord

Question 6

what are the components of the spermatic cord? (4)

Answer 6

1. vas deferens
2. testicular artery
3. pampiniform venous plexus
4. obliterated processus vaginalis

Question 7

what does the ilioinguinal nerve innervate?

Answer 7

the scrotum and labium majus canal

Question 8

what does the genital branch of the genitofemoral nerve innervate?

Answer 8

motor innervation to the cremasteric muscles and sensory innervation to the scrotum and medial thigh

Question 9

what is the bassini repair?

Answer 9

• the apeuroneurosis of the transversus abdominis mm is approximated to the shelving edge of the inguinal ligament

Question 10

what is the shouldice repair?

Answer 10

the transversalis fascia is divided from the internal ring to the pubic tubercle, the fascia is then imbricated to itself and the inguinal ligament with two suture lines

Question 11

what is the mcvay repair?

Answer 11

aka cooper ligament repair

• the floor of the inguinal canal is excised and reconstructed by initially approximating the transversus abdominis aponeurosis and transversalis fascia to the cooper ligament
• closes off the femoral canal
• procedure of choice for femoral hernia

Question 12

what are two unique complications of inguinal hernia repair?

Answer 12

1. Testicular atrophy: consequence of ischemic orchitis

2. Neuralgia

Question 13

What are the three different methods of laparoscpic repair of groin hernias?

Answer 13

1. TAPP: transabdominal preperitoneal repair
2. TEP: total extraperitoneal repair
3. IPOM: intraperitoneal onlay mesh repair

Question 14

what are the contraindications to laparoscopic repair of groin hernias? (5)

Answer 14

1. large scrotal hernias or incarcerated hernias
2. previous lower abdominal surgery
3. previous prostatectomy
4. history of pelvic irradiation
5. coagulopathy or must be on anticoagulation during OR

Question 15

what is the triangle of doom?

Answer 15

area where apex is the internal ring, and extends medially to vas deferens and laterally to spermatic vessels, contains the iliac artery and vein

Question 16

triangle of pain?

Answer 16

area bounded superiorly by the iliopubic tract, medially by spermatic vessels, contains the lateral femoral cutaneous and genitofemoral nerves

Question 17

what is a spigelian hernia?

Answer 17

weakness in the spigelian fascia where the transversus abdominis aponeurosis joins the edge of the rectus sheath forming the semilunar line

Question 18

what is grynfelt triangle?

Answer 18

the superior lumbar triangle, more common hernia site

• medially by the quadratus lumborum muscle
• laterally by the internal abdominal oblique muscle
• superiorly by the 12th rib.

Question 19

what is petit triangle?

Answer 19

the inferior lumbar triangle

• iliac crest inferiorly
• latissimus dorsi (posteriorly)
• external abdominal oblique (anteriorly).

Question 20

what are obturator hernias? patient population and presentation?

Answer 20

• defects that occur through obturator canal
• elderly women, high mortality
• assoc with radicular pain extending down the medial thigh with abduction or internal rotation of the thigh (howship-romberg sign)

Question 21

what is the Howship-Romberg sign?

Answer 21

radicular pain extending down the medial thigh with abduction or internal rotation of the thigh
- seen in obturator hernias

Question 22

how do you repair an obturator hernia?

Answer 22

transabdominal approach

Question 23

treatment of ischemic orchitis after hernia repair?

Answer 23

NSAIDs

Question 24

What is the Rives-Stoppa-Wantz ventral hernia repair?

Answer 24

mesh placed between the rectus muscle and the posterior rectus sheath

Question 25

what is the stoppas repair for ventral hernias?

Answer 25

mesh is placed between the rectus muscle and the anterior rectus sheath