Surgical Procedures Exam 1

Front 1

Areas of inguinal occurrence

Back 1

inguinal canals, femoral rings, umbilicus, epigastric, and hiatal

Front 2

contributing factors

Back 2

age, gender, previous surgery, obesity, nutrition, pulmonary disease, cardiac disease

Front 3

anatomy related to type of hernia: inguinal

Back 3

inguinal area lateral to the pubic area

Front 4

anatomy related to type of hernia: femoral

Back 4

very upper edge f thigh, just below inguinal area

Front 5

anatomy related to type of hernia: incisional or ventral

Back 5

area of previous incision or front of the abdomen

Front 6

anatomy related to type of hernia: umbilicus

Back 6

umbilicus

Front 7

anatomy related to type of hernia: spigelian

Back 7

lateral to the linea alba (center line of abdominal muscle)

Front 8

Direct hernias

Back 8

occur within the Hesselbach triangle.

Front 9

Indirect Hernias

Back 9

occur anywhere but in Hesselbach's triangle.

Front 10

Supplies for inguinal hernia repair

Back 10

Minor basic tray & self retaining retractor. (weitlander or gelpi) -Laparotomy pack - suction, x-ray sponges, bovie pencil, penrose drain, suture (absorbable and non-absorbable), ESU

Front 11

Patient position etc

Back 11

Supine

Front 12

Anesthetic

Back 12

Local (spinal) or regional block

Front 13

Prep

Back 13

above and sl. lateral to umbilicus, groin, external genitalia

Front 14

Suture

Back 14

transversalis fascia, heavy non-absorbable (0 or 1 prolene); mesh/plus MAY be used here -Scarpas fascia- medium absorbable (2-0 or 3-0) vicryl -Skin nonasborbable (4-0) or staples

Front 15

procedure for inguinal herniorraphy
incise via inguinal hernia or oblique incision - hemostasis

Back 15

-retract skin and subcutaneous (goelet, army-navy, or appendix richardson) - open external oblique aponeurosis (scalpel and forceps)

Front 16

2- preserve nerves - open cremaster muscle

Back 16

2 retract spermatic cord with moistened penrose drain- pass on a kelly 2- explore cord for indirect sac (if present), dissect away from cord

Front 17

3- open sac & return abdominal contents to peritoneal cavity - purse string suture for base of sac

Back 17

-remove excess of sac -if possible approximate transversalis fascia edges with non-absorbable suture (0 prolene or Surgilon) on control release needle

Front 18

4- procedure for inguinal herniorraphy cont. - if unable, may need to suture fascia to cooper's ligament

Back 18

-cremaster muscle closed - close exterior oblique m. aponeurosis, scarpa's fascia and skin - dress wth telfa & 4x4 gauze; may also use steri strips

Front 19

instructions from surgeon

Back 19

Verbal and written: Discharge planning begins on admission Wound care- report signs of infection - Males wear scrotal support Ice packs to decrease swelling

Front 20

Activity (instructions cont.)

Back 20

occupation related - use proper body mechanics- early ambulation

Front 21

advantages of herniorraphy

Back 21

faster return to activity - less post-op adhesions - smaller incisions (3-4) - Less post- op pain - minimal dissection - better for bilateral and recurrent hernias

Front 22

Disadvantages of herniorraphy

Back 22

- higher costs - higher learning curve - longer operating time - need for general anesthesia - more visceral and vascular complications

Front 23

laparoscopic hernia repair preparation supplies instruments and equipment

Back 23

gen.gyn laparoscopy tray and camera- laparoscopy pack -suction, x-ray sponges, bovie pencil, clip applier, mesh, trocars, insufflation tubing, irrigation, aspiration tubing, suture( absorbable and non) -ESU - tower with camera, monitor, insufflator, light source, VCR

Front 24

patient position and prep

Back 24

reverse trendelenberg, anesthesia (general) - prep above and lateral to umbilicus, groin, external genitalia

Front 25

1 create pneumoperitoneum (carbon dioxide gas via verres needle attached to insufflation tubing) - trocar placement (2nd & 3rd under direct visualization via camera & monitor)

Back 25

-hemostasis (bovie) - identify landmarks (vas deferens, spermatic vessels, arteries and veins

Front 26

2 Dissect fat and peritoneum away from muscle wall and spermatic cord (dissectors and laparoscopic scissors) - place mesh in direct space defect

Back 26

Place mesh over defect in inguinal area + secure with staples - Re-approximate peritoneal flaps with staples

Front 27

3 Irrigate peritoneal cavity- remove instruments & release pneumoperitoneum

Back 27

Close incisions - Steri strips for dressing

Front 28

Possible Complications Lap Hernia Rep.

Back 28

Reccurence, Nerve injury, Ischemic orchitis, and testicular atrophy, loss of bowel function, infection, complications associated with all open procedures (e.g., hemorrhage, dehiscence), etc.