Flashcards in EXAM #3: HERNIAS Deck (39)
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1
Q
What is the general school of thought for the surgical management of hernias?
A
Repair before they cause problems
2
Q
What is the most common type of all hernias?
A
Inguinal
*Far more common in men*
*Far more common in men*
3
Q
Review the abdominal wall layers.
A
1) Skin
2) Subcutaneous tissue
- Camper's Fascia (fatty)
- Scarpa's Fascia (fibrous)
3) External Oblique
4) Internal Oblique
5) Transversus Abdominis m.
6) Transversalis fascia
7) Peritoneum
2) Subcutaneous tissue
- Camper's Fascia (fatty)
- Scarpa's Fascia (fibrous)
3) External Oblique
4) Internal Oblique
5) Transversus Abdominis m.
6) Transversalis fascia
7) Peritoneum
4
Q
Review the anatomy of the inguinal canal.
A
N/A
5
Q
What is an indirect inguinal hernia?
A
- Hernia through the internal inguinal ring
- Lateral to the inferior epigastric vessels
- Within the spermatic cord
MD's Don't Lie
- Lateral to the inferior epigastric vessels
- Within the spermatic cord
MD's Don't Lie
6
Q
Where does a direct inguinal hernia pass through?
A
Hasselbach's Triangle
7
Q
What is a direct inguinal hernia?
A
Hernia that occurs
- Adjacent to rectus abdominus
- Medial to inferior epigastirc vessels
- Superior to inguinal ligament
- Adjacent to rectus abdominus
- Medial to inferior epigastirc vessels
- Superior to inguinal ligament
8
Q
What patient's more commonly have femoral hernias?
A
Female
9
Q
What is a femoral hernia?
A
Hernia that passes into the femoral canal, below the inguinal ligament
10
Q
How can an inguinal hernia be repaired with a "tissue repair?"
A
1) Bassini repair= single layer reconstruction of inguinal floor
2) Shouldice repair= four layer reconstruction of inginal floor
3) McVay repair= inguinal floor brought to Cooper's Ligament--closes the femoral space
2) Shouldice repair= four layer reconstruction of inginal floor
3) McVay repair= inguinal floor brought to Cooper's Ligament--closes the femoral space
11
Q
What is the best tissue repair for an incarcerated femoral hernia?
A
McVay b.c is closes the femoral repair
12
Q
Why perform a tissue repair?
A
1) No mesh available
2) INFECTION
2) INFECTION
13
Q
What is the current standard hernia repair?
A
Lichtenstein Mesh Repair
14
Q
What are the key characteristics of a Lichtenstein Mesh Repair?
A
1) Mesh reconstruction of inguinal floor
2) Tension-free
*Lowest risk of recurrence
2) Tension-free
*Lowest risk of recurrence
15
Q
What is the risk of a Lichtenstein Mesh Repair?
A
Prosthetic mesh infection
16
Q
What is a Pre-Peritoneal Mesh Repair?
A
Mesh is placed INSIDE of fascia (vs. outside)
*Mesh is between peritoneum and transversus abdominus*
*Mesh is between peritoneum and transversus abdominus*
17
Q
How do you place pre-peritoneal mesh?
A
Open or Laparoscopic
18
Q
What are the benefits of Laparoscopic repair for pre-peritoneal mesh repair?
A
1) Less post-op pain
2) Less infection and hematoma
3) Quicker recovery with fewer work restrictions
2) Less infection and hematoma
3) Quicker recovery with fewer work restrictions
19
Q
What are the two approaches to the pre-peritoneal repair?
A
TAP and TEP
20
Q
What is the TAP approach?
A
TransAbdominal Preperitoneal Laparoscopic Hernia Repair
21
Q
What is the TEP approach?
A
Total Extraperitoneal Preperitoneal
22
Q
How does the TEP differ from the TAP?
A
TAP= standard laprascopic approach
TEP= entry in RECTUS SHEATH
TEP= entry in RECTUS SHEATH
23
Q
What are the evidence-based indications for laprascopic hernia repair?
A
1) Bilateral inguinal hernias
2) Comorbid umbilical
3) Young healthy individual that wants to return to work earlier
2) Comorbid umbilical
3) Young healthy individual that wants to return to work earlier
24
Q
What is a Spigelian hernia?
A
Hernia along the semilunar line
25
Q
What is the difference between an umbilical hernia in a kid and adult?
A
Kid= frequently regress (congenital)
Adult= acquired and progress/enlarge
Adult= acquired and progress/enlarge
26
Q
How are umbilical hernias repaired?
A
1) Primary if 1-2cm
2) Mesh reinforcement for 2cm+ defects
2) Mesh reinforcement for 2cm+ defects
27
Q
What is an incisional hernia?
A
Failure of fascia healing
28
Q
What are the risk factors for incisional hernias?
A
Infection
Early return to work
Obesity
Old-age
Male
Sleep apnea*
Emphysema*
*Chronic hypoxia states
Early return to work
Obesity
Old-age
Male
Sleep apnea*
Emphysema*
*Chronic hypoxia states
29
Q
How long should people be lifting restricted to prevent an incisional hernia?
A
6 weeks
30
Q
What is a unique feature of epigastric hernias?
A
Small defect above the umbilicus that is PAINFUL
*Repaired to alleviate pain
*Repaired to alleviate pain
31
Q
What is the proposed etiology of Spigelian Hernias?
A
Vascular defects of the semilunar lines
32
Q
What is a primary repair for an abdominal wall hernia?
A
Cut down a simply suture the defect
*Note that these are associated with a high recurrence rate
*Note that these are associated with a high recurrence rate
33
Q
When is a primary repair done for a hernia?
A
1) Strangulation
2) Skin breakdown
3) Bowel resection
2) Skin breakdown
3) Bowel resection
34
Q
What is a mesh reinforeced repair for an abdominal wall hernia?
A
Mesh is placed to help reinforce the defect
35
Q
When is a mesh reinforced repair CONTRAindicated?
A
Contaminated field/ infection
36
Q
Where is abdominal wall mesh placed most commonly?
A
"Underlay" i.e. intraperitoneal
37
Q
What is the gold standard for abdominal wall mesh placement?
A
"Retrorectus" i.e posterior to the rectus sheath
38
Q
Is an incarcerated hernia a surgical emergency?
A
NO--an incarcerated hernia is one that cannot be reduced
*****A STRANGULATED hernia is an incarcerated hernia with compromised blood flow/ infection; this is a surgical emergency*****
*****A STRANGULATED hernia is an incarcerated hernia with compromised blood flow/ infection; this is a surgical emergency*****
39
Q
What are the clinical features of a strangulated hernia?
A
1) Erythema of the overlying skin
2) Fever
3) Tachycardia
4) Elevated WBC count
2) Fever
3) Tachycardia
4) Elevated WBC count
