abdominal wall & groin hernias

Question 1

operative approaches that can address both inguinal and femoral hernias:

Answer 1

TEP repair and McVay

Question 2

vicryl (polyglycolic-acid mesh) properties:

Answer 2

absorbable; can be used in contaminated fields

Question 3

polypropylene mesh properties:

Answer 3

becomes incorporated into native tissue

Question 4

PTFE (Polytetrafluoroethylene) mesh properties:

Answer 4

macroporous, lightweight mesh that allows higher bacterial clearance than microporous; does not incorporate into native tissue

Question 5

biologic mesh properties:

Answer 5

composed of acellular collagen matrix and theoretically promotes neovascularization and collagen deposition; can be used in contaminated fields

Question 6

what nerve supplies sensation to the upper anterior thigh and groin

Answer 6

genital branch of genitofemoral nerve

Question 7

ideal overlap for lap ventral hernia with intraperitoneal mesh placement:

Answer 7

3-5 cm

Question 8

most common groin hernias in males and females

Answer 8

indirect inguinal hernias

Question 9

location of femoral hernias

Answer 9

lateral to pubic tubercle and below inguinal ligament

Question 10

borders of femoral canal:

Answer 10

posterior - Cooper’s ligament
anterior - inguinal/poupart ligament
lateral - femoral vein
medial - lacunar ligament (junction of iliopubic tract and coopers)

Question 11

direct hernia is a weakness of ____

Answer 11

transversalis fascia

Question 12

which type of groin hernias require repair because of their high risk of incarceration and strangulation

Answer 12

femoral hernias

Question 13

indirect hernia is ____ to inferior epigastric vessels

Answer 13

lateral

Question 14

contents of inguinal canal:

Answer 14

spermatic cord (or round ligament), ilioinguinal nerve, genital branch of genitofemoral nerve

Question 15

most commonly injured nerves in laparoscopic inguinal hernia repair:

Answer 15

genitofemoral and lateral femoral cutaneous

Question 16

type of biologic mesh that delays neovascularization and cellular infiltration; uses chemical to render the collagen of the biologic matrix less prone to degradation by naturally occurring collagenases; acts like a foreign body and becomes encapsulated with fibrous tissue

Answer 16

cross-linked biologic mesh

Question 17

type of biologic mesh that promotes vascularization and cellular ingrowth

Answer 17

non-crosslinked biologic mesh

Question 18

in what tissue plane to biologic meshes work best?

Answer 18

when placed between two layers of vascularized tissue that promote fibroblate and vessel ingrowth within the scaffold

Question 19

suturing properties important for fascial closure to prevent incisional hernia:

Answer 19

suture length to wound ratio of higher than 4:1; 2-0 monofilament running suture placed 5-8mm from wound edge and 4-5mm apart

Question 20

true or false: mesh in the retrorectus position has a lower complication rate (including recurrence) than overlay or underlay positions

Answer 20

true

Question 21

features of large pore, lightweight mesh:

Answer 21

better tissue incorporation of mesh which is thoguht to help reduce recurrence and infection

Question 22

artery most likely to be injured during open inguinal herniorrhaphy

Answer 22

inferior epigastric - branch of external iliac immediately above the inguinal ligament

Question 23

True or false. asymptomatic inguinal hernias can safely be observed due to low risk of incarceration

Answer 23

true. less than 1% risk

Question 24

Which nerve in open inguinal hernia surgery will result in numbness of the ipsilateral thigh and scrotum if injured?

Answer 24

genitofemoral nerve - sensation to thigh and groin

Question 25

True or false. Watchful waiting/monitoring can be used when a Spigelian hernia is detected.

Answer 25

False. All spigelian hernias should be repaired

Question 26

True or false. The use of acellular dermal matrix results in lower rates of SSI when used for abdominal wall repair in the presence of heavy contamination.

Answer 26

True. additionally less hernia recurrences and fewer complications compared with synthetic mesh for example - abdominal hernia with enterocutaneous fistula

Question 27

True or false. Biologic mesh offers lower rates of fistula recurrence compared to synthetic mesh after repair.

Answer 27

true

Question 28

True or false. SSI and recurrence of a hernia is higher for primary fascial closures with mesh reinforcement than bridged repairs with mesh.

Answer 28

False. bridged repair has high complications for both biologic and synthetic

Question 29

True or false. There is no advantage to using biologic mesh rather than synthetic mesh for crural closure and parastomal hernias.

Answer 29

True.