Flashcards in The Surgical Review- Hernia Deck (25)
What are the borders of the inguinal canal?
anterior: aponeurosis of the external oblique
posterior: transversalis fascia
superior: aponeurosis of the internal oblique
inferior: inguinal ligament
what are the borders of the femoral hernia?
medial: lacunar ligament
lateral: common femoral vein
superior: inguinal ligament
inferior: cooper ligament
what is the deep inguinal ring?
a defect in transversalis fascia approx halfway between the ASIS and the pubic tubercle
- spermatic cord and round ligament exit the abdominal cavity and enter the inguinal canal
what is hesselbachs triangle?
- through which direct inguinal hernia protrudes
1. Inferior epigastric artery laterally
2. Inguinal ligament inferiorly
3. Rectus sheath medially
what is an indirect hernia?
protrudes LATERAL to the inferior epigastric artery and anteromedial to the spermatic cord
what are the components of the spermatic cord? (4)
1. vas deferens
2. testicular artery
3. pampiniform venous plexus
4. obliterated processus vaginalis
what does the ilioinguinal nerve innervate?
the scrotum and labium majus canal
what does the genital branch of the genitofemoral nerve innervate?
motor innervation to the cremasteric muscles and sensory innervation to the scrotum and medial thigh
what is the bassini repair?
- the apeuroneurosis of the transversus abdominis mm is approximated to the shelving edge of the inguinal ligament
what is the shouldice repair?
the transversalis fascia is divided from the internal ring to the pubic tubercle, the fascia is then imbricated to itself and the inguinal ligament with two suture lines
what is the mcvay repair?
aka cooper ligament repair
- the floor of the inguinal canal is excised and reconstructed by initially approximating the transversus abdominis aponeurosis and transversalis fascia to the cooper ligament
- closes off the femoral canal
- procedure of choice for femoral hernia
what are two unique complications of inguinal hernia repair?
1. Testicular atrophy: consequence of ischemic orchitis
What are the three different methods of laparoscpic repair of groin hernias?
1. TAPP: transabdominal preperitoneal repair
2. TEP: total extraperitoneal repair
3. IPOM: intraperitoneal onlay mesh repair
what are the contraindications to laparoscopic repair of groin hernias? (5)
1. large scrotal hernias or incarcerated hernias
2. previous lower abdominal surgery
3. previous prostatectomy
4. history of pelvic irradiation
5. coagulopathy or must be on anticoagulation during OR
what is the triangle of doom?
area where apex is the internal ring, and extends medially to vas deferens and laterally to spermatic vessels, contains the iliac artery and vein
triangle of pain?
area bounded superiorly by the iliopubic tract, medially by spermatic vessels, contains the lateral femoral cutaneous and genitofemoral nerves
what is a spigelian hernia?
weakness in the spigelian fascia where the transversus abdominis aponeurosis joins the edge of the rectus sheath forming the semilunar line
what is grynfelt triangle?
the superior lumbar triangle, more common hernia site
- medially by the quadratus lumborum muscle
- laterally by the internal abdominal oblique muscle
- superiorly by the 12th rib.
what is petit triangle?
the inferior lumbar triangle
- iliac crest inferiorly
- latissimus dorsi (posteriorly)
- external abdominal oblique (anteriorly).
what are obturator hernias? patient population and presentation?
- defects that occur through obturator canal
- elderly women, high mortality
- assoc with radicular pain extending down the medial thigh with abduction or internal rotation of the thigh (howship-romberg sign)
what is the Howship-Romberg sign?
radicular pain extending down the medial thigh with abduction or internal rotation of the thigh
- seen in obturator hernias
how do you repair an obturator hernia?
treatment of ischemic orchitis after hernia repair?
What is the Rives-Stoppa-Wantz ventral hernia repair?
mesh placed between the rectus muscle and the posterior rectus sheath