Hernias

Question 1

Superficial and fatty fascial layer

Answer 1

Camper’s

Question 2

Deep and membranous fascial layer

Answer 2

Scarpa’s

Question 3

Superior to the arcuate line of Douglas, the anterior sheath is composed of the

Answer 3

EO and IO aponeuroses

Question 4

Superior to the arcuate line of Douglas, the posterior sheath is composed of the

Answer 4

IO aponeurosis and transversalis fascia

Question 5

Inferior to the arcuate line, the posterior sheath is composed only of

Answer 5

transversalis fascia

Question 6

Deep inguinal ring arises from

Answer 6

Transversalis fascia

Question 7

Superficial inguinal ring arises from

Answer 7

External oblique aponeurosis

Question 8

Arises from thickened portion of EO and connects the anterior superior iliac spine to the pubic tubercle.

Answer 8

Inguinal (Poupart’s) ligament

Question 9

Medial, fan-shaped aspect of inguinal ligament that joins inguinal ligament at the pubic tubercle to the pectineal line of pubis.

Answer 9

Lacunar (Gimbernat’s) ligament

Question 10

Arises from the inferior aspect of transversalis fascia, parallel and deep to the inguinal ligament.

Answer 10

Iliopubic tract

Question 11

Arises from a thickening of the fascia at the pectineal line and appears to extend from the lacunar ligament.

Answer 11

Cooper’s (pectineal) ligament

Question 12

Arises from IO and transversus abdominus aponeuroses.

Answer 12

Conjoint tendon (falx inguinalis)

Question 13

Preperitoneal space behind pubic symphysis. Site of laparoscopic hernia repairs.

Answer 13

Space of Retzius

Question 14

Bordered by the inguinal ligament inferiorly, lateral border of the rectus sheath medially, and the inferior epigastric vessels superiolaterally.

Answer 14

Hesselbach’s triangle

Question 15

Femoral hernias occur at what aspect of femoral canal

Answer 15

Medial

Question 16

Inguinal hernias are more common on what side

Answer 16

Right

Question 17

Location of indirect hernial sac relative to the cord

Answer 17

Anteromedial

Question 18

Weakness in what fascia results to direct inguinal hernia

Answer 18

Transversalis fascia

Question 19

Boundaries of the inguinal canal

Answer 19

Anterior: EO
Posterior: Transversalis fascia
Roof: IO, transversus abdominus
Floor: Inguinal ligament

Question 20

Direct vs indirect hernia: reduce with supine position

Answer 20

Direct

Question 21

High ligation with repair of inguinal floor. Involves approximation of transversalis fascia, conjoint tendon, and shelving edge of inguinal ligament.

Answer 21

Bassini

Avoid sutures in the pubic tubercle to minimize incidence of osteitis pubis.

Question 22

Primary repair utilizing continuous running sutures in multiple layers.

Answer 22

Shouldice

Question 23

Closure involves Cooper’s ligament. Used for both inguinal and femoral hernia repairs.

Answer 23

McVay

Question 24

Tension-free repair that is used for direct and indirect hernias.

Answer 24

Lichtenstein

Avoid a mesh repair if infection is present.

Question 25

"Plug and Patch” hernia repair

Answer 25

Stoppa repair

Question 26

In hernia repair, staples must be avoided in this area lateral to femoral vessels and below iliopubic tract

Answer 26

trapezoid of doom

Question 27

Structures in the trapezoid of doom

Answer 27

Lateral cutaneous, femoral branch of genitofemoral, and femoral nerves

Question 28

Most common early complication of hernial repair

Answer 28

Urinary retention

Question 29

Loss of cremasteric reflex and sensation to ipsilateral penis, scrotum, and medial thigh is an injury to

Answer 29

Ilioinguinal injury

Question 30

Loss of sensation to the lower abdominal wall and inguinal region is an injury to

Answer 30

Iliohypogastric injury

Question 31

Loss of sensation to the upper lateral thigh or loss of scrotal sensation and cremasteric motor function is injury to

Answer 31

Genitofemoral injury

Question 32

Inguinal vs femoral hernia: greater incidence of incarceration and strangulation due to narrow neck.

Answer 32

Femoral

Question 33

Repair for femoral hernia

Answer 33

McVay

Question 34

The most commonly injured nerve during hernia repair.

Answer 34

ilioinguinal nerve Superior to the cord

Question 35

Umbilical hernia arises from facial defect in

Answer 35

Linea alba

Question 36

Repair of small, childhood umbilical hernias (

Answer 36

4

Question 37

Hernia through the linea semilunaris, particularly where the line of Douglas intersects the linea semilunaris.

Answer 37

Spigelian

Question 38

Hernia through the inferior lumbar triangle (boundaries: posterior edge of the EO, latissimus dorsi, and iliac crest).

Answer 38

Petit’s

Question 39

Hernia through the superior lumbar triangle (boundaries: 12th rib, serratus, IO, quadratus lumborum, and erector spinae).

Answer 39

Grynfeltt’s

Question 40

Midline hernia through muscular aponeuroses that form the linea alba, in an area extending from xiphoid to umbilicus.

Answer 40

Epigastric

Question 41

Hernia through the obturator foramen in pelvis; lie anteromedial to obturator nerve and vessels; most common in elderly women.

Answer 41

Obturator Howship-Romberg sign

Question 42

Hernia involving one wall of bowel. Can cause ischemia and strangulation, leading to perforation without associated obstruction.

Answer 42

Richter’s

Question 43

Hernia involving a Meckel’s diverticulum.

Answer 43

Littre’s

Question 44

Combination of indirect and direct inguinal hernias that straddle the inferior epigastric vessels.

Answer 44

Pantaloon

Question 45

Sliding indirect hernia involves what organs?

Answer 45

Ovary, fallopian tube, cecum, sigmoid colon, bladder

Question 46

During a McVay repair, bleeding is encountered. What is a possible source?

Answer 46

Aberrant obturator artery

Question 47

An 80 year old has a medial thigh pain with leg abduction, internal rotation, or extension. Diagnosis?

Answer 47

Obturator hernia Operative procedure

Question 48

A 45 year old man has a dull groin ache and painful ejaculation after an inguinal hernia repair. What therapy will cure his symptoms?

Answer 48

Vasectomy Dysejaculation syndrome (partial obstruction of the vas deferens