Cah Absite:

Front 1

McVay Repair

Back 1

the transversalis fascia is sutured to Cooper ligament medial to the femoral vein, and the inguinal ligament at the level of and lateral to the femoral vein (often requires relaxing incision medially on aponeurosis of internal oblique). closes femoral space effective for femoral hernias

Front 2

Bassini Operation

Back 2

the inferior arch of the transversalis or conjoint tendon is approximated to the shelving portion of the inguinal ligament. Used for simple, indirect hernias, including inguinal hernias in women

Front 3

Lichtenstein tension-free repair with mesh

Back 3

polypropylene mesh is used to recreate the inguinal floor. mesh is sutured to to pubic tubercle, transversalis fascia + conjoint tendon and inguinal ligament laterally

Front 4

Howship-Romberg Sign

Back 4

used to identify an obterator hernia. It is inner thigh pain on internal rotation of the hip

Front 5

Grynfeltt hernia

Back 5

herniation of abdominal components through superior lumbar triangle (scarospinus, internal oblique, 12th rib)

Front 6

Richter Hernia

Back 6

part (rather than the entire circumference of the bowel wall is trapped)

Front 7

Littre Hernia

Back 7

one that contains a Meckel's diverticulum

Front 8

Obturator hernia

Back 8

pelvic or abdominal contents protrudes through the obturator foramen. Common in old multiparous women

- narrow canal prone to strang.

- primary closure difficult because poor surrounding tissue

- CT aids diagnosis

Front 9

Differences between open and laparoscopic hernia repair

Back 9

- recurrence is more common in lap

- rate of complications higher in lap

- lap group: less initial pain, earlier return to work

- recurrence rates after repair of recurrent hernias was similar

Front 10

T/F open hernia repair is superior to lap repair

Back 10

T

Front 11

Femoral hernia

Back 11

- pass posterior (deep) to inguinal ligament

- repairs that only repair inguinal ligament (Bassini) have no effect

- essential elements: dissection and removal of hernia sac; obliteration of defect in femoral canal (approximate ileopubic tract to cooper ligament or by placement of mesh)

- last stitch: transition stitch and includes inguinal ligament

Front 12

Complication of femoral hernia repair

Back 12

compression of external iliac vein-->post-op venous thrombosis with transition stitch

Front 13

Direct Infra-inguinal approach to femoral hernia

Back 13

- uses infrainguinal incusion

- after ligating sac, cigarette plug is inserted into defect

- don't use is cases of strangulation

Front 14

pediatric hernia

Back 14

- patent process vaginalis

- generally no weakness of floor of inguinal canal, thus high ligation of sac necessary except in rare cases where hernia is huge

- more common in right

- always try to reduce before operating (75-80% success rate)

Front 15

obturator canal

Back 15

pubic bone + ischium

Front 16

umbilical hernia

Back 16

- failure of umbilical ring to close, central defect in linea alba in kids, acquired in adults

- defects <1 cm, tend to close before age 2, elective repair considered at age 4/5

- rarely incarcerate but more common in adults

- patients with ascites should undergo repair so overlying skin doesn't thin and die (consider TIPS prior)

- all complications similar between primary and mesh except recurrence

Front 17

Spigelian Hernia

Back 17

hernia through aponeurotic layer between the rectus abdominis muscle medially, and the semilunar line laterally. These are generally interparietal hernias, meaning that they do not lie below the subcutaneous fat but penetrate between the muscles of the abdominal wall; therefore, there is often no notable swelling.

- all are at or below arcuate line

Front 18

pantaloon hernia

Back 18

direct and indirect hernia co-existing

Front 19

Petit hernia

Back 19

bound by latissimus dorsi, iliac crest and external oblique

Front 20

Ischemic orchitis following hernia

Back 20

- swollen, tender testicle 2-3 days following surgery

- extensive dissection of spermatic cord (esp. large hernia sac)

- ?thrombosis of veins of pampiniform plexus leading to testicular venous congestion

- expectant management

- more common in recurrent surgery using ant. approach (consider going lap)

Front 21

consequence of high ligation of testicular artery

Back 21

- rich collaterals including external spermatic artery and artery to the vas) so accidental ligation is often okay

Front 22

Genitofemoral nerve

Back 22

- L1/L2

- genital branch innervates cremasteric muscle and senation to side of scrotum

- in women accompanies the round ligament

- iliopubic tract w/ cremasteric fibers

- passes through deep ring

Front 23

iliioinguinal nerve

Back 23

lies on top of spermatic cord

- intervates internal oblique, sensory to medial thigh

- T12/ L1

- intermingles with iliohypogastric

- passes through superficial ring

Front 24

iliohypogastric

Back 24

- bae of penis, upper medial thigh

on internal oblique

Front 25

approach is re-exploring due to chronic pain after hernia repair

Back 25

posterior approach

Front 26

poupart ligament

Back 26

- inguinal liagment

- antero-inferior portion of external oblique folding back on itself

Front 27

cremasteric fibers

Back 27

arise from internal oblique and surround spermatic cord

Front 28

femoral hernia anatomy

Back 28

inguinal ligament anteriorly cooper ligament posteriorly, femoral vein laterally, pubic tubercle = apex

- femoral hernia passes through this space and medial to femoral vessles

Front 29

arcuate line

Back 29

- above acruate: ant sheath: ext +ant; post sheath = inter +transvesalis

- below: ant: all three, no posterior sheath (rectus lies on transversalis fascia)

Front 30

hernia commoness

Back 30

- indirect most common for all

- femoral hernias: rare in men

- aortic anuerysm: risk factor