L1: Hernia - Pt 6

Question 1

Anatomical Overview of Femoral Hernia

Answer 1

Question 2

Incidence of Femoral Hernia

Answer 2

Question 3

Incidence of Femoral Hernia

• Why is it more common in females?

Answer 3

Question 4

Etiology of Femoral Hernia

Answer 4

Always acquired pulsion sac is formed (due to increased intra-abdominal pressure & weak abdominal wall)

Question 5

Structure of Femoral Hernia

Answer 5

Question 6

Structure of Femoral Hernia

• defect

Answer 6

Femoral ring

Question 7

Structure of Femoral Hernia

• Sac

Answer 7

Question 8

Structure of Femoral Hernia

• Contents

Answer 8

• Usually contain omentum, intestine or urinary bladder.
• Richter’s hernia is common

Question 9

Structure of Femoral Hernia

• Coverings

Answer 9

Question 10

Subtypes of Femoral Hernia

Answer 10

Question 11

CP of Femoral Hernia

Answer 11

Question 12

CP of Femoral Hernia

• site

Answer 12

In the femoral triangle below the inguinal ligament, and below & lateral to the pubic tubercle.

Question 13

CP of Femoral Hernia

• Direction of Descent

Answer 13

Downwards, forwards then upwards & laterally.

Question 14

CP of Femoral Hernia

• Direction of Reduction

Answer 14

Downwards then backwards & finally upwards.

Question 15

CP of Femoral Hernia

• Special Tests

Answer 15

PRESSURE ON SAPHENUS OPENING: Prevents descent of hernia.

INTERNAL RING TEST: the hernia appears below the inguinal lig.

ZEIMAN’S TEST: impulse on cough below inguinal ligament

Question 16

DDx of Femoral Hernia

Answer 16

Question 17

DDx of Femoral Hernia

• inguinal Hernia

Answer 17

Question 18

DDx of Femoral Hernia

• Other Swellings in The Femoral Triangle

Answer 18

Question 19

TTT of Femoral Hernia

Answer 19

Question 20

TTT of Femoral Hernia

• Laparoscopic Hernioplasty

Answer 20

• By synthetic mesh
• It’s increasingly popular & recommended nowadays

Question 21

TTT of Femoral Hernia

• Open Surgery

Question 22

Open Surgery in Femoral Hernia

Question 23

Open Surgery in Femoral Hernia

• High Inguinal Approach (Letheissen’s Operation)

Answer 23

Question 24

High Inguinal Approach (Letheissen’s Operation) in Femoral Hernia

• Use

Answer 24

Commonly Used

Question 25

High Inguinal Approach (Letheissen's Operation) in **Femoral Hernia** - technique

Answer 25

Question 26

High Inguinal Approach (Letheissen's Operation) in **Femoral Hernia** - Advantages

Answer 26

(The reverse of disadvantages of low approach). **From Notes**

Question 27

High Inguinal Approach (Letheissen's Operation) in **Femoral Hernia** - Disadvantages

Answer 27

1. Disturbs shutter mechanism. 2. Weakens the posterior wall of inguinal canal.

Question 28

High McEvedy's Approach in **Femoral Hernia**

Answer 28

Question 29

High McEvedy's Approach in **Femoral Hernia** - Technique

Answer 29

Question 30

High McEvedy's Approach in **Femoral Hernia** - Advantages

Answer 30

Reverse of disadvantages of the other 2 operations **From Notes**

Question 31

High McEvedy's Approach in **Femoral Hernia** - Best for ....

Answer 31

strangulated femoral hernia

Question 32

Low Approach in **Femoral Hernia**

Answer 32

Question 33

Low Approach in **Femoral Hernia** - Technique

Answer 33

A transverse incision 1/2 inch below & parallel to the inguinal ligament over the hernia.

Question 34

Low Approach in **Femoral Hernia** - Disadvantages

Answer 34

1. The sac cannot be excised at the proper neck → recurrence. 2. Strangulated bowel can not be dealt with. 3. Associated inguinal hernia can not be not dealt with. 4. Injury to an abnormal obturator artery is common in strangulation if the constriction is relieved by cutting the sharp border of lacunar ligament.

Question 35

**Umbilical Hernia** - Types

Answer 35

Congenital - Infantile - Adult paraumbilical.

Question 36

Etiology of **Congenital Umbilical Hernia**

Answer 36

Failure of midgut to return to the abdomen during early fetal life.

Question 37

Types of **Congenital Umbilical Hernia**

Answer 37

Question 38

Compare Between **Exomphalas Minor (Minor omphalocele)** & **Exomphalos Major (Major omphalocele)**

Answer 38

Question 39

Compare Between **Exomphalas Minor (Minor omphalocele)** & **Exomphalos Major (Major omphalocele)** - Structure

Answer 39

Question 40

Compare Between **Exomphalas Minor (Minor omphalocele)** & **Exomphalos Major (Major omphalocele)** - Complications

Answer 40

Question 41

Compare Between **Exomphalas Minor (Minor omphalocele)** & **Exomphalos Major (Major omphalocele)** - TTT

Answer 41

Question 42

Etiology of **Infantile Umbilical Hernia**

Answer 42

Question 43

**Infantile Umbilical Hernia** - Structure

Answer 43

Question 44

Structure of **Infantile Umbilical Hernia** - Defect

Answer 44

* It is exactly in the umbilicus, * It is usually closed spontaneously before the age of 2 years

Question 45

Structure of **Infantile Umbilical Hernia** - Sac

Answer 45

Wide neck ----> no complications & easy reducible.

Question 46

Structure of **Infantile Umbilical Hernia** - contents

Answer 46

Intestine or omentum.

Question 47

Structure of **Infantile Umbilical Hernia** - Coverings

Answer 47

Extraperitoneal fat and stretched umbilical scar

Question 48

CP of **Infantile Umbilical Hernia**

Answer 48

Question 49

TTT of **Infantile Umbilical Hernia**

Answer 49

Question 50

TTT of **Infantile Umbilical Hernia** - TTT of the Cause

Answer 50

Remove the cause of straining.

Question 51

TTT of **Infantile Umbilical Hernia** - Usual Measures

Answer 51

Question 52

TTT of **Infantile Umbilical Hernia** - Surgical hernioraphy

Answer 52