Chapter 35: Hernias- IntraOP Questions

Question 1

What is the first identifiable subcutaneous named layer?

Answer 1

Scarpa’s fascia (thin in adults)

Question 2

What is the name of the subcutaneous vein that is ligated?

Answer 2

Superficial epigastric vein

Question 3

What happens if you cut the ilioinguinal nerve?

Answer 3

Numbness of inner thigh or lateral scrotum; usually goes away in 6 months

Question 4

From what abdominal muscle layer is the cremaster muscle derived?

Answer 4

Internal oblique muscle

Question 5

From what abdominal muscle layer is the inguinal ligament (a.k.a. “Poupart’s ligament”) derived?

Answer 5

External oblique muscle aponeurosis

Question 6

To what does the inguinal (Poupart’s) ligament attach?

Answer 6

Anterior-superior iliac spine to the pubic tubercle

Question 7

Which nerve travels on the spermatic cord?

Answer 7

Ilioinguinal nerve

Question 8

Why do some surgeons deliberately cut the ilioinguinal nerve?

Answer 8

First they obtain preoperative consent and cut so as to remove the risk of entrapment and postoperative pain

Question 9

What is in the spermatic cord (6)?

Answer 9

1. Cremasteric muscle fibers
2. Vas deferens
3. Testicular artery
4. Testicular pampiniform venous plexus
5. ± Hernia sac
6. Genital branch of the genitofemoral nerve

Question 10

What is the hernia sac made of?

Answer 10

Peritoneum (direct) or a patent processus vaginalis (indirect)

Question 11

What attaches the testicle to the scrotum?

Answer 11

Gubernaculum

Question 12

What is the most common organ in an inguinal hernia sac in men?

Answer 12

Small intestine

Question 13

What is the most common organ in an inguinal hernia sac in women?

Answer 13

Ovary/fallopian tube

Question 14

What lies in the inguinal canal in females instead of the VAS?

Answer 14

Round ligament

Question 15

Where in the inguinal canal does the hernia sac lie in relation to the other structures?

Answer 15

Anteromedially

Question 16

What is a “cord lipoma”?

Answer 16

Preperitoneal fat on the cord structures (pushed in by the hernia sac); not a real lipoma; remove surgically, if feasible

Question 17

What is a small outpouching of testicular tissue off the testicle?

Answer 17

Testicular appendage (a.k.a. “the appendix testes”); remove with electrocautery

Question 18

What action should be taken if a suture is placed through the femoral artery or vein during an inguinal herniorrhaphy?

Answer 18

Remove the suture as soon as possible and apply pressure (i.e., do not tie thesuture down!)

Question 19

What nerve is found on top of the spermatic cord?

Answer 19

Ilioinguinal nerve

Question 20

What nerve travels within the spermatic cord?

Answer 20

Genital branch of the genitofemoral nerve

Question 21

What are the borders of Hesselbach’s triangle?

Answer 21

Epigastric vessels

Inguinal ligament

Lateral border of the rectus

Question 22

What type of hernia goes through Hesselbach’s triangle?

Answer 22

Direct hernia due to a weak abdominal floor

Question 23

What is a “relaxing incision”?

Answer 23

Incision(s) in the rectus sheath to relax the conjoint tendon so that it can be approximated to the reflection of the inguinal ligament without tension

Question 24

What is a conjoint tendon?

Answer 24

Aponeurotic attachments of the “conjoining” of the internal oblique and transversus abdominis to the pubic tubercle

Question 25

Define inguinal anatomy

Answer 25

1. Inguinal ligament (Poupart’s ligament)
2. Transversus aponeurosis
3. Conjoint tendon

Question 26

How tight should the new internal inguinal ring be?

Answer 26

Should allow entrance of the tip of a Kelly clamp but not a finger (the new external inguinal ring should not be tight and should allow entrance of a finger)

Question 27

What percentage of the strength of an inguinal floor repair does an external oblique aponeurosis represent?

Answer 27

ZERO