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38 Cards in this Set
- Front
- Back
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DDX: Groin Mass
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Lymphadenopathy
Femoral Aneurysm Hematoma, Seroma, Hydrocele Epidermal Inclusion Cyst Undescended Testicle Sarcoma, Undescended Testicle Testicular Torsion Lipoma Saphenous Varix |
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Incidence of Inguinal Hernias in Children
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3% of all chidlren
up to 30% of premature infants |
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Who gets inguinal hernias
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6:1 Males over Females
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which side more commonly has an inguinal hernia:
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Right side 60%
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% of inguinal hernias which are bilateral
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15%
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how is a pediatric inguinal hernia repaired? why?
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high ligation of hernia sac, no wall reconstruction
recurrence risk is 1% only need to keep overnight is <3mos |
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Incidence of Direct Inguinal Hernia
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1% of all men, frequency increases with age
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Incidence of Indirect Inguinal Hernia
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5% of all men
most common hernia in both men and women |
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Probability of strangulation with going hernias
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Femoral > Indirect > Direct
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Bassini Repair
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Sutures to approximate poupart's inguinal ligament to transversis abdominus (conjoint tendon)
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McVay Inguinal Hernia Repair
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Cooper's Inuinal ligament Sutured to trasnversus Abdominus Aponeurosis (Conjoint Tendon)
For Femoral Hernias |
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Shouldice Repair
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Imbrication of the floor of inguinal Canal
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Plug and Patch
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Place of plug of mesh in hernia defect and then overlaying path of mesh over inguinal floor
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High Ligation repair
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Ligationa nd Trasnection of Indirect henria sac without repairof inguinal floor
only used in children |
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Indication for laparoscopic inguinal hernia repair
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1. Bilateral
2. recurrant 3. Need to resume full activity asap |
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Scarpa's Fascia:
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External Fascia of External Oblique
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What happens when you cut the ilioinguinal nerve:
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numbness of inner thigh/lateral scrotum
usually resolves after 6 months |
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What is in the Spermatic Cord:
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3 Wall layers
External Spermatic Cord from External Oblique Cremasteric Muscle from Internal Oblique Internal Spermatic Cord from Transversus Abdominus 3 Arteries: Testicular (from Abdominal Aorta), Cremasteric (from Inferior Epigastric) Deferenatial (from superior vesical artery) 3 Nerves: Ilioinguinal (outside cord), Genital Branch of the Genitofemoral (cremaster/dartos), ANS fibers 3 Others: Pampiniform Plexus, Ductus Deferens or Round Ligament, Lymphatics |
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What is the most common organ found in an inguinal hernia?
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Men: Small Intestine
Women: Ovary/Fallopian Tube |
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Where int he inguinal canal does the hernia sac lie in relation to spermatic cord
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anteromedially
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What is a cord lipoma
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preperitoneal fat pushed into inguinal canal by hernia
Not a true lipoma, remove with eelctrocautery |
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hasselbach's triangle
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Epigatrics, inguinal ligamnet, rectus abdominus
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Relaxing Incision in Inguinal Hernia Repair
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Cut into rectus SHEATH to relax conjoint tendon for tension free repair
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Conjoint Tendon
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apnoneurotic conjoining of internal oblique and transversus abdominus to pbuci tubercle
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How tight should a new inguinal ring be:
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Kelly clamp but not finger
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What percentage of the strenght of an inguinal floor repair does the extenral oblique aponeurosis respresnent:
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zero
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Boundaries of femoral canal
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Coopers ligament posteriorly
Inguinal ligament anteriorly Femoral Veing Laterally Lacunar ligament medially |
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% of hernias which are femoral, associated with whom
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5%
women, pregnancy & excertion NB: 85% of femoral hernias are female, but Most common hernia in women is indrect inguinal hernia |
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Describe the steps to repair an indirect inguinal hernia
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cut skin, cut through fat, then scarpa's fascia, then extenral oblique through the extenral inguinal ring.
find hernia sac anteriomedially blutnly separate inguinal sac from other cord strux ligate sack high at neck resect sack and allow stump to retract close extenral oblique close scarpa's fascia, close skin |
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Scrotal mass transilluminates, is this a rule out for inguinal henria
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not in babies, baby bowel wall is extremely thin
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eponym: fossa between the testicle and the epididymis
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fossa of geraldi
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how can the opposite side be assessed for a hernia intraoperatively?
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laparoscope into the open side
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Eponym: Hernia with meckel's diverticulum in sac
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Littre's inguinal hernia
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yellow/orange non-fatty tissue on spermatic cord
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adrneal rest
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small outpouching of testicular tissue off testicle
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testicular appendage/appendix
should be removed with electrocuatray |
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blue dot sign
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blue dot on scrotal skin from twisted tesicular appendage
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tx: transected vas deferens
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primary anastomosis
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tx: transected ilioinguinal nerve
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no repair
loss of sensation to inner thigh/scrotum loss of cremasteric reflex may return in 6 months |
