Ventral Hernias

Question 1

The mainstay of hernia diagnosis is:

Answer 1

based on clinical findings.

Question 2

A patient presents with a recurring hernia that is complex in nature. The BEST imaging modality for diagnosis is:

Answer 2

CT

Question 3

Physical examination of an abdominal hernia is done with the patient:

(1) supine
(2) standing
(3) valsalva maneuver

Answer 3

All of these

Question 4

T/F: Hernia defects < 2 cm can be closed primarily.

Answer 4

True.

Question 5

All femoral hernias require:

Answer 5

surgery.

Question 6

A truss is

Answer 6

A support device that sits over groin and prevents hernia from coming out; is used for femoral hernias when surgery is contraindicated.

Question 7

The standard of care in the USA for inguinal hernias is:

Answer 7

Mesh repairs

Question 8

Mesh use reduces recurrence rates of inguinal hernias. It is useful for hernias that are:

Answer 8

> 2 - 3 cm.

Question 9

Emergent operative intervention of hernias is indicated for:

(1) acute incarceration with inability to reduce hernia contents.
(2) hernia content strangulation.
(3) bowel obstruction with signs of bowel ischemia.
(4) Leakage of ascites through the skin in a patient with cirrhosis.

Answer 9

All of these.

Question 10

Indications for elective hernia repair include:

Answer 10

(1) pain or discomfort
(2) high risk for bowel obstruction
(3) interference with daily activities affecting the patient’s quality of life.

Question 11

Which of the following patients is contraindicated for hernia repair (relative)?

(1) Low BMI
(2) Former smoker
(3) Pregnancy
(4) Good surgical candidate with no comorbidities.

Answer 11

(3) pregnancy is a relative contraindication for hernia repair.

Question 12

An absolute contraindication to surgical hernia repair is:

Answer 12

Inability to withstand general anesthesia if the operation requires it.

Question 13

There is a posterior rectus sheath beneath the arcuate line.

Answer 13

False.

Question 14

A 43 year old male presents with a hernia above the linea alba above the umbilicus. Imaging suggests congenital variation in the pattern of the linea alba. The defect is small. Diagnosis and treatment of this hernia is:

Answer 14

Epigastric hernia; since it is small, it can be closed primarily.

Question 15

Epigastric hernias may be due to areas of weakness in the:

Answer 15

epigastrium.

Question 16

A 34 year old female who is 2 months post-partum presents with diastasis recti. The condition:

(1) Is an attenuation of the linea alba with a true fascial defect.
(2) Requires correction in infants.
(3) Treatment in this patient is abdominal wall exercises and weight loss.

Answer 16

(3) Treatment of diastasis recti in adults are abdominal wall exercises to strengthen the musculature and weight loss.

Question 17

Umbilical hernias are commonly:

(1) Congenital
(2) Acquired in children

Answer 17

(1) Congenital, but may be acquired in adults.

Question 18

The umbilicus is the area where:

Answer 18

the round ligament, urachus and obliterated umbilical arteries coverge.

Question 19

Umbilical hernias occur in pediatric patients due to:

Answer 19

When the normal umbilical ring present at birth to allow passage of umbilical vessels doesn’t close soon after birth.

Question 20

A pediatric patient presents with an umbilical hernia if there are symptoms of:

(1) abdominal pain
(2) incarceration
(3) skin maceration

Answer 20

All of these.

Question 21

Surgical repair of umbilical hernia in pediatric patients is usually:

Answer 21

closed primarily.

Question 22

Obesity, ascites, pregnancy, significant physical activity and chronic distention are all conditions that cause:

Answer 22

umbilical hernias in adults.

Question 23

Repair of adult umbilical hernias involves:

Answer 23

Curvilinear incision (identify hernia sac, fascial defect, intact surrounding fascia); Hernia and its contents are reduced, fascial edges are reapproximate for small defects OR brought together with a mesh.

Question 24

A patient presents with a hernia and also has cirrhosis of the liver. In regard to cirrhosis and hernias:

(1) Cirrhotic patients are not at increased risk for hernias.
(2) There is no increased risk of perioperative morbidity and mortality.
(3) If it is filled with ascites alone, do elective repair.
(4) if the hernia is not reducible and has evidence of strangulation, emergent repair is required.

Answer 24

(3) If it is filled with ascites alone, do elective repair.

(4) If the hernia is not reducible and has evidence of strangulation, emergent repair is required.

Question 25

Incisional hernias refer to:

Answer 25

hernias that develop at a site of previous surgical incision in the abdominal wall; (vertical midline incisions of anterior abdominal wall).

Question 26

You are going to surgically repair a large hernia. Surgical repair of this hernia requires:

(1) Relaxing incisions along the anterior rectus sheath.
(2) Mesh should be secured with absorbable monofilament sutures.
(3) Recurrence rate for mesh repair is higher than recurrence rate for incisional hernias.

Answer 26

(1) Surgical repair of the hernia may require relaxing incisions along the anterior rectus sheath.

Question 27

Component separation is used for:

Answer 27

very large defects that cannot be brought together without tension.

Question 28

Component separation involves:

Answer 28

Dividing the fascial planes between muscle groups to allow for more coverage on either side of the incision.

Question 29

A patient presents with an abdominal hernia that is large and cannot be brought together without tension. You decide to do component separation with skin flaps. When doing this procedure:

Answer 29

Closed suction drains should be placed in the subcutaneous space above the mesh to prevent post-op collections.

Question 30

A spigelian hernia is:

(1) A defect in the fascia between the rectus muscle, excluding the semilunar line.
(2) Due to a lack of posterior sheath below the arcuate line.
(3) A palpable bulge that is posterior to the external oblique.

Answer 30

A Spigelian hernia is (2) due to a lack of posterior sheath below the arcuate line and the hernia develops at OR below the arcuate line.

Question 31

A Spigelian hernia present as:

(1) A large hernia > 2 cm
(2) diffuse pain with a bulge
(3) At higher risk for incarceration because of narrow neck.

Answer 31

Spigelian hernia is (3) at higher risk for incarceration because of a narrow neck.

Question 32

A patient presents with an obturator hernia. You note that there is a defect in the obturator membrane that has caused this condition. The hernia is present at:

Answer 32

Obturator hernias present as a bulge in the proximal medial thigh.

Question 33

Symptoms of obturator hernia include the Howship-Romberg sign. This presents as:

Answer 33

pain radiating down the medial thigh that is relieved by thigh flexion.

Question 34

T/F: 50% of obturator hernias present with bowel obstruction.

Answer 34

True.

Question 35

A lumbar hernia presents as:

(1) It is at the superior (Grynfeltt) lumbar triangle (12th rib superiorly), medially by the quadratus lumborum, laterally by the internal oblique.
(2) It may be found at the inferior (Petit) lumbar triangle.
(3) I is prone to incarceration.
(4) It is symptomatic and presents with back pain.

Answer 35

A lumbar hernia may present at the superior (Grynfeltt) lumbar triangle OR the (2) inferior (Petit) lumbar triangle.

Question 36

Parastomal hernias:

(1) Have a low incidence.
(2) They occur after colostomies and may develop in up to 50% of stomas.
(3) Obesity, high intra-abdominal pressure or creation of an ostomy are non-related risk factors.

Answer 36

(2) Parastomal hernias occur after colostomies and may develop in up to 50% of stomas.

Question 37

Diagnosis of a parastomal hernia is made via

Answer 37

CT or US.

Question 38

When choosing mesh as treatment for hernia repair:

(1) Do not excise the hernial sac.
(2) close the fascial defect with tension.
(3) Avoid mesh placement in contaminated fields; use primary repair or a biologic or absorbable mesh.

Answer 38

When choosing mesh as treatment for hernia repair, (3) avoid mesh placement in contaminated fields; use primary repair or a biologic or absorbable mesh.