SRGR RCL HRN

Question 1

What is it?
Hernia within the floor of Hesselbach’s triangle, that is, the hernia sac does not
traverse the internal r

Answer 1

Direct inguinal hernia

Question 2

What is the cause of direct inguinal hernia?

Answer 2

Acquired defect from mechanical breakdown over the years

Question 3

What nerve runs with the spermatic cord in the inguinal canal?

Answer 3

Ilioinguinal nerve

Question 4

Cause of indirect inguinal hernia

Answer 4

PPV

Question 5

Incidence of direct inguinal hernia

Answer 5

1% of men

Question 6

Incidence of indirect inguinal hernia

Answer 6

5% of all men

Question 7

most common inguinal hernia

Answer 7

indirect inguinal hernia

Question 8

How is an inguinal hernia diagnosed?

Answer 8

mainly on hx and pe

Question 9

What is the risk of strangulation?

a. higher with indirect hernia than femoral hernia
b. highest in femoral hernias
c. higher in direct than indirect hernia
d. NOTA

Answer 9

Higher with indirect than direct inguinal hernia, but highest in femoral hernias

Question 10

Sutures approximate reflection of inguinal ligament (Poupart’s) to the transversus abdominis aponeurosis/conjoint tendon

a. Bassini
b. McVay
c. Lechenstein
d. plug and patch

Answer 10

A

Question 11

Cooper’s ligament sutured to transversus abdominis aponeurosis/conjoint
tendon
a. Bassini
b. McVay
c. Lechenstein
d. plug and patch

Answer 11

B

Question 12

“Tension-free repair” using mesh

Answer 12

Lichtenstein

Question 13

Placing a plug of mesh in hernia defect and then overlaying a patch of mesh
over inguinal floor (requires few if any sutures in mesh!)

Answer 13

plug and patch

Question 14

Ligation and transection of indirect hernia sac without repair of inguinal floor
(used only in children)

Answer 14

High ligation

Question 15

What are the indications for laparoscopic inguinal hernia repair?

Answer 15

1. Bilateral inguinal hernias
2. Recurring hernia
3. Need to resume full activity as soon as possible

Question 16

What is the first identifiable subcutaneous named layer?

Answer 16

Scarpa’s fascia (thin in adults)

Question 17

What is the name of the subcutaneous vein that is ligated?

Answer 17

Superficial epigastric vein

Question 18

What happens if you cut the ilioinguinal nerve?

Answer 18

Numbness of inner thigh or lateral scrotum; usually goes away in 6 months

Question 19

From what abdominal muscle layer is the cremaster muscle

derived?

Answer 19

Internal oblique muscle

Question 20

From what abdominal muscle layer is the inguinal ligament (a.k.a.
“Poupart’s ligament”) derived?

Answer 20

External oblique muscle aponeurosis

Question 21

To what does the inguinal (Poupart’s) ligament attach?

Answer 21

Anterior-superior iliac spine to the pubic tubercle

Question 22

Which nerve travels on the spermatic cord?

Answer 22

Ilioinguinal nerve

Question 23

Why do some surgeons deliberately cut the ilioinguinal nerve?

Answer 23

remove the risk of

entrapment and postoperative pain

Question 24

What is the hernia sac made of?

Answer 24

Peritoneum (direct) or a patent processus vaginalis (indirect)

Question 25

What attaches the testicle to the scrotum?

Answer 25

Gubernaculum

Question 26

What is the most common organ in an inguinal hernia sac in men?

Answer 26

Small intestine

Question 27

What is the most common organ in an inguinal hernia sac in | women?

Answer 27

Ovary/fallopian tube

Question 28

What lies in the inguinal canal in females instead of the VAS?

Answer 28

Round ligament

Question 29

Where in the inguinal canal does the hernia sac lie in relation to the other structures?

Answer 29

Anteromedially

Question 30

Preperitoneal fat on the cord structures (pushed in by the hernia sac); not a real lipoma; remove surgically, if feasible

Answer 30

cord lipoma

Question 31

What is a small outpouching of testicular tissue off the testicle?

Answer 31

Testicular appendage

Question 32

What nerve is found on top of the spermatic cord?

Answer 32

Ilioinguinal nerve

Question 33

What nerve travels within the spermatic cord?

Answer 33

Genital branch of the genitofemoral nerve

Question 34

What are the borders of Hesselbach’s triangle?

Answer 34

1. Epigastric vessels 2. Inguinal ligament 3. Lateral border of the rectus

Question 35

What type of hernia goes through Hesselbach’s triangle?

Answer 35

Direct hernia due to a weak abdominal floor

Question 36

What is a “relaxing incision”?

Answer 36

Incision(s) in the rectus sheath to relax the conjoint tendon so that it can be approximated to the reflection of the inguinal ligament without tension

Question 37

Aponeurotic attachments of the of the internal oblique and | transversus abdominis to the pubic tubercle

Answer 37

conjoint tendon