Surgical technique & technology

Question 1

How do you differentiate between a direct and indirect hernia

Answer 1

Direct-within Hasselbach’s triangle/ medial to inferior epigastric vessels

Indriect-outside Hasselbach’s triangle/ lateral to inferior epigastric vessels

Question 2

On examination, how do you differentiate between a direct and indirect hernia

Answer 2

Pressure over deep inguinal ring and ask patient to cough

-if hernia PRODUCED = DIRECT
-if hernia NOT PRODUCED = INDIRECT

Question 3

What are the borders of Hasselbach’s triangle

Answer 3

Medial- rectus abdominis
Lateral- inferior epigastric vessels
Inferior- inguinal ligament

Question 4

Indications for open hernia repair

Answer 4

First time hernia repair
Unilateral hernia

Question 5

Indications for laparoscopic hernia repair

Answer 5

Recurrent hernia
bilateral hernia

Question 6

Indications for emergency hernia repair

Answer 6

Neonatal (high risk of strangulation)
Strangulated hernia
incarcerated hernia
femoral hernia

Question 7

Types of hernia repair

Answer 7

Bassini- suture transversalis fascia + conjoint tendon to inguinal ligament (NO mesh) HIGH recurrence

Shouldice repair- 4 layer repair and fascia sutured to inguinal ligament

Lichensteins repair- with mesh

Question 8

What are the borders of the inguinal canal

Answer 8

M: transversus abdominis + internal oblique muscles

A: External oblique Aponeurosis

L: Inguinal + lacunar ligament

T: Conjoint tendon + transversalis fascia

remember MALT!!

Question 9

Contents of the inguinal canal

Answer 9

M+F:
-Ilioinguinal nerve + Genital branch of genitofemoral nerve

M:
spermatic cord

F:
round ligament of uterus

Question 10

What is the rule of 3’s in relation to the spermatic cord?

Answer 10

3 fascia layers
3 arteries
3 nerves
3 other structures

Question 11

What are the structures that make up the spermatic cord

Answer 11

3 fascia= external, cremasteric, internal spermatic fascia

3 arteries= testicular, cremasteric, artery of vas deferens

3 nerves= ilioinguinal, genital branch of GF and sympathetic + visceral afferent nerves

3 other= vas deferens, pampiniform peluxus, testicular lymphatics

Question 12

Which sutures are absorbable

Answer 12

vicryl
monocryl
PDS

Question 13

Which sutures are non-absorbable

Answer 13

nylon
prolene
silk
ethibond

(PENS!)

Question 14

Which sutures are monofilament vs braided

Answer 14

mono:
-PDS
-Prolene
-monocryl
-nylon

braided:
-vicryl
-silk
-ethibond
-

Question 15

H.pylori is a gram _____ organism

Answer 15

NEGATIVE

Question 16

What enzyme produced by H.pylori is detected by the CLO test

Answer 16

Urease

Question 17

What reaction does urease act on in the stomach

Answer 17

urea to ammonia

Question 18

How does the presence of H pylori cause gastritis

Answer 18

Urea converted to ammonia by urease

Ammonia acts on antral G cells to produce gastrin

Gastrin increases acidity and damages gastric epithelium

Gastritis and ulcers

Question 19

What are the 3 criteria needed for an anastomosis to heal

Answer 19

-good blood supply
-minimal tension
-mucosal apposition

Question 20

what type of suture is best for vascular anastomosis

Answer 20

monofilament
non-absorbable
small size (6/0)

eg: prolene

Question 21

what shape needle is best for vascular anastomosis

Answer 21

round bodied

Question 22

what is neo-intimal hyperplasia

Answer 22

when vascular smooth muscle cells migrate to and proliferate to areas of the tunica intima post-intervention thus causing thickening of the wall of the blood vessel and blockage