HERNIAS Flashcards Preview

General Surgery > HERNIAS > Flashcards

Flashcards in HERNIAS Deck (33):
1

Femoral Nerve

Motor and sensory to thigh (quads)

2

Genitofemoral nerve

Motor--cremasteric muscle Sensory--genital region

3

Lateral femoral cutaneous nerves

Skin to lateral portion of thigh (often sacrificed)

4

Hesselbach's Triangle

Medial: rectus sheath Inferior: inguinal ligament Superolateral: inferior epigastric vessels

5

Hernia Dx

Bulge in inguinal region Minor pain or vague discomfort or extreme pain (incarceration) Paresthesias if inguinal nerves are compressed

6

Reducing a hernia

Gentle continuous pressure on the hernial mass toward the inguinal ring in the Trendelenburg position

7

Radiology

Only used in ambiguous diagnosis NOT FIRST LINE US (pretty good)

8

Hernia Severity

Reducible --> Incarcerated --> Strangulated

9

Indirect inguinal hernia

Congenital lesion Bowel, omentum, other abdominal organs protrude through abdominal ring with patent processus vaginalis *Indirect hernia cannot develop if processus vaginalis does not remain patent* Most common type of hernia

10

Direct inguinal hernia

Proceeds directly through posterior inguinal wall Acquired lesions Older males Pressure and tension on muscles and fascia

11

Femoral Hernias

Mass below the inguinal ligament More common in females than males

12

RFs for inguinal hernias

Family history (8x more likely) Connective tissue disorders Smoking Coughing COPD Obesity Straining Pregnancy Ascites Prematurity, low birth weight Heavy listing

13

Does wearing a truss cure a hernia?

No

14

When to surgically repair a hernia

If they are symptomatic

15

When to repair emergently

Strangulation of hernia -Fever, leukocytosis, hemodynamic instability -Hernia bulge is warm and tender -Overlying skin may be erythematous or discolored -Sx of bowel obstruction

16

Bassini Repair

Original procedure Used for indirect and small direct hernias Closing the area with the patient's own tissue Higher rates of recurrence

17

McVay (Cooper's ligament) Repair

Inguinal and femoral hernia repairs

18

Shouldice (Canadian) Repair

Most commonly used Reduced recurrence rate Using patient's own tissue to close defect Genitoformoral nerve is divided; loss of sensation on scrotum/mons pubis and labia majora

19

The Operation

Incision: 2 finger breadths above inguinal ligament Dissect through subcutaneous and external oblique fascia Mobilize spermatic cord Divide/separate cremasteric muscle fibers from underlying cord structures Dissect hernia sac from cord structures; open Suture ligate neck of sac at level of internal ring

20

Which procedures use the patient's own tissue?

Bassini McVay Shouldice

21

Lichtenstein (tension-free) Repair

Very common Mesh patch is sutured over defect with a slit to allow passage of the spermatic cord Laparoscopic > Open Recurrence rate is even lower Preferred method

22

Which procedure cannot be used if suspected/known strangulated or incarcerated hernia?

TEPA --Opt for TAPP instead

23

What are the three issues with laparoscopic hernia repair?

Triangle of doom Triangle of pain Circle of death

24

Triangle of doom

Medial border: vas deferens Lateral border: vessels of spermatic cord Posterior border: peritoneal edge Contents: external iliac vessels, deep circumflex iliac vein, femoral nerve, genital branch of genitofemoral nerve

25

Triangle of pain

Iliopubic tract and gonadal vessels Contents: lateral femoral cutaneous, femoral branch of genitofemoral, and femoral nerves

26

Circle of death

Vascular continuation formed by the common iliac, internal iliac, obturator, inferior epigastric, and external iliac vessels

27

IHR Complications

Recurrence Chronic groin pain Cord and testicular (hematoma, ischemic orchitis, division of vas deferens, hydrocele) Bladder injury Wound infection Hematoma Prosthetic complications

28

Abdominal wall hernias

Ventral hernias Congenital: defective midline fusion Acquired: slow architectural deterioration or from failed healing of abdominal wall incision

29

Umbilical hernias

Mostly congenital in origin African descent Usually close by age 5 After 5, surgically repair If presenting in adulthood, considered acquired

30

Umbilical hernia repair

After age 5 Primary sutured repair or placement of prosthetic mesh for larger defects (> 2 cm) using open or laparoscopic methods

31

Spigelain Hernia

"S belt" (6 cm horizontal region below navel, lateral to abdominal muscles) Men around age 50, right side STILL FIX IF ASYMPTOMATIC Simple closure of fascia

32

Incisional Hernias

Development of hernia following surgery (up to 20%) Paramedian incisions help reduce the risk Inadequate healing-- not following instructions, post-op strain, infection Obesity is a leading cause (must lose weight before repair) Other RFs: advanced age, malnutrition, ascites, post op hematoma, pregnancy

33

Incisional hernia repair: mesh locations

Underlay: deep to defect (done laparoscopically) Interlay: bridging the gap or within the abdominal wall Onlay: superficial to fascial defect -Laparoscopic preferred