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38 Hernias
absite
46
Accounting
Undergraduate 1
12/03/2017

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Term
inguinal canal roof =
Definition
external abd oblique
Term
conjoined tendon =
Definition
Int abd oblique + Tversalis fascia
= FLOOR
Term
what ligaments do fem vessels pass thru?
Definition
between inguinal and pectineal
Term
Floor of ing canal =
Definition
conjoined tendon
Term
Hesselbach triangle =
Definition
rectus
inguinal lig
inf epigastrics
Term
direct vs indirect anatomy
Definition
w/in triangle..2/2 floor weakness

indirect = lateral to epigastrics = MC type
2/2 persistently patent processus vag
Term
direct vs indirect..
-MC type
-Higher recurrence risk
-higher incarceration risk
Definition
MC type = indirect
MC reucrrence = direct (MEN>WOMEN)
MC incarceration = indirect
Term
sliding hernia
-def
-MC type
Definition
-sac made up of visceral peritoneum from retroP structure
-cecum or sig @ men (MC gender)
-ovaries or fallopians @ female
Term
mgmt
-sliding hernia w/ovary
Definition
-ligate the round ligament, then reduce ovary back to peritoneum
Term
location of vas in cord?
Definition
medial to cord structures
Term
Bassini =
Definition
conjoined/transversalis to ing-lig
= floor reconstruction
Term
McVay =
Definition
Coopers lig repair
-Conjoined/transversalis to coopers
*make relaxing incision in ext abd oblique*
Term
Lichtenstein =
Definition
mesh between conjoined and inguinal lig
-dec recurrence
Term
recurrence rate after lap inguinal hernia?
Definition
4%
Term
MCC recurrence after lap ing. hernia ?
Definition
medial separation of mesh from fascia @ inguinal ligament
*mesh is too small or failed to attach it medially*
Term
inguinal hernia in elderly
-pre op considerations?
Definition
make sure no straining from colon CA etc or BPH
Term
Severe COPD pt needing inguinal repair
-approach?
Definition
under local w/ilioinguinal nerve block
Term
can't reduce inguinal hernia contents @ time of repair
-mgmt?
Definition
1. divide ing. lig @ internal ringt
2. incise into abd wall muscles staying extra-peritoneal (better for direct)
3. laparotomy
Term
@ time of inguinal repair, find a femoral hernia that you cant reduce
-mgmt
Definition
cut through inguinal ligament and floor of canal..?then do a McVay?
Term
Inguinal hernia Cx
1. MC early cx
2. wound infxn rate
3. recurrence rate
Definition
1. urinary retention
2. 1%
3. 1% (lower w/mesh)
Term
Inguinal hernia repair
-pphys testicular atrophy
Definition
2/2 dissection of distal hernia sac ==>vessel disruption and spermatic cord vein thrombosis
*MC after indirect repair*
Term
MC inguinal hernia nerve injury
Definition
ilioinguinal nerve
-MC @ external ring
??loss of cremasteric reflex, ispilat penis/scrotum/thigh numbness??
Term
relative location of ilioinguinal nerve
Definition
anterior to cord structure
Term
MC nerve injury w/lap inguinal hernia?
Definition
genitofemoral nerve
-genital br = cremaster and scrotum sensation
-femoral br = lateral thigh sensation (runs lateral to iliacs)
Term
fem canal boundaries
Definition
Sup = ing lig
medial = lacunar lig
inf = pectineal lig
lateral = fem vein
Term
fem hernia repair =
Definition
McVay (coopers)
Term
First port location vs ventral hernia
Definition
LUQ open hassan
Term
% injury w/veress needle
Definition
0.1%
Term
type of mesh/sutures for lap ventral hernia?
Definition
dual mesh (PTFE inside)
prolene sutures to hold it up, then tacks
Term
% recurrence w/primary ventral hernia repair?
Definition
20%
Term
MCC ventral hernia recurrence after repair?
Definition
5%
-separation of mesh from posterior fascia
Term
MC cx after ventral hernia repair
Definition
seroma
(aspirate if sxs)
Term
age for umbo repair in kids?
Definition
5 years
Term
spigelian hernia
-location
-MC side
Definition
-lat border rectus (thru linea semi-lunaris)
inf to semi-curcularis (below umbo, no post sheath)
-in the int abd oblique aponeurosis
*usually no bulge, MC right side
*high incarceration risk
Term
Sciatic hernia
-pres/location
Definition
-painful mass in gluteal area
-herniation thru greater sciatic foramen
*high strangulation rate*
Term
Obturator hernia
-pres/rf
Definition
-thru obturator canal. bowel gas below sup pubic ramus. Howship romberg sign
-RF elderly women, multiparous
Term
Howship romberg sign =
Definition
inner thigh pain w/int rotation
-2/2 obturator hernia
Term
obturator hernia
-tx
Definition
operative reduction w/mesh
-check other side
-dx usually @ time of operation for bowel obstruction
Term
Richters hernia =
-definition
-unique pres
Definition
non-circumferential incarceration of non-mesenteric bowel wall
-can cause strangulation and perf w/ou obstruction
Term
Petit's hernia
-definition
-borders
Definition
inferior lumbar triangle hernia
-borders =
1. external abd oblique
2. lat dorsi
3. iliac crest
Term
Littre hernia
Definition
incarcerated Meckle's divertic
Term
MC type of hernia to recur =
Definition
incisional hernia
Term
Parastomal hernia
-type with inc incidence-->tx?
Definition
-colostomies (50% @ 5 year)-->only tx if sxs
Term
parastomal hernia
-tx
Definition
-best = relocation of ostomy
1. true hernia: remove/replace in rectus m
2. pseudohernia: 2/2 to being placed in oblique
3. prolapse: don't relocate..fix mesentery
Term
anatomic point where posterior sheath stops
Definition
semicircularis
-below umbo
Term
Fothergill sign
Definition
pain w/rectus muscle flexion
-rectus sheath hematoma
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