ABSITE - Hernias - Questions
You are comparing a fifty five-year-old woman for a painful lump in her right groin for several
days. She denies fever, chills, nausea or emesis, has been having ordinary bowel and
bladder characteristic, and is in in any other case terrific health. Physical examination
reveals a solitary three-cm soft, firm, spherical mass in her proper groin under the inguinal
ligament and not using a skin discoloration. She has a pre-paid excursion scheduled in 3
days. At this factor, you would propose:
A. Observation with reevaluation after her excursion
B. Urgent hernia repair
C. Elective hernia repair following her holiday
D. Analgesics and tried reduction of the mass
E. Aspiration of the mass with ultrasound steering - ANSUrgent hernia repair
Correct.
The affected person's records and physical exam are regular with an incarcerated femoral
hernia, which calls for on the spot operation to avoid progression to strangulation, ischemia
and perforation of involved bowel. Complications are highly possibly on this putting. Although
tried reduction underneath analgesia and sedation is affordable, this isn't always endorsed
for femoral hernias. There isn't any function for needle aspiration of a groin mass while a
hernia is suspected.
A healthy forty-12 months-antique man is consulting with you for assessment of intermittent
left groin soreness (4 out of 10 on pain scale) which has been gift for the beyond three
weeks. These symptoms have induced him to miss paintings occasionally. He denies any
constitutional signs, and has no other complaints at this time. On physical examination, you
can't hit upon a hernia, despite provocative maneuvers (i.E., Valsalva, cough). Your advice at
this time would be:
A. Computed tomography (CT) of the stomach and pelvis with oral and intravenous contrast
for further assessment
B. Diagnostic laparoscopy
C. Contrast herniography (peritoneography)
D. Left groin exploration with feasible inguinal hernia repair
E. Ultrasonography of the left groin - ANSUltrasonography of the left groin
Correct.
This patient might also have an occult inguinal hernia which isn't detectable on bodily
examination. Ultrasonography, herniography and CT are all beneficial diagnostic studies,
with ultrasound being the least invasive, less expensive, and with high sensitivity and
specificity. In this affected person with minimum signs, there is no indication for immediate
laparoscopy or groin exploration.
A 60-year-old male affords with persistent pain over his right lower stomach six months after
a bilateral TEPP laparoscopic inguinal hernia restore. There is no evidence of hernia
recurrence, seroma or infection on bodily exam. As a part of your research, you bought a
, undeniable stomach radiograph, which reveals a couple of bilateral spiral tacks throughout
the decrease stomach. You attain the operative file, and affirm your suspicion that the
medical professional used permanent spiral tacks for mesh fixation. Injury to which of the
following nerves is the maximum in all likelihood purpose for his chronic ache?
A. Ilioinguinal nerve
B. Iliohypogastric nerve
C. Genital branch of the genitofemoral nerve
D. Lateral femoral cutaneous nerve
E. Femoral nerve - ANSIliohypogastric nerve
Correct.
Post-herniorrhaphy neuralgia has been pronounced to arise in up to 20% of cases. Injury to
any of the nerves cited can result in publish-herniorrhaphy neuralgia. Given the place of the
affected person's symptoms and the approach used for mesh fixation, the iliohypogastric
nerve is the maximum at risk of injury in the course of laparoscopic mesh fixation.
A 67-yr-old man affords with vomiting and belly distension. An abdominal x-ray
well-knownshows air/fluid tiers suggesting small bowel obstruction. On examination, her
abdomen is distended with diffuse tenderness and there is a soft mass within the right groin.
At operation, you resect a strangulated 6-cm phase of small gut and there is moderate
contamination with bowel contents. What should you do for the hernia?
A. Complete the operation and plan a subsequent hernia restore.
B. Perform a repair the use of polypropylene mesh.
C. Perform a repair the usage of biologic mesh.
D. Perform a tissue-based totally repair. - ANSPerform a tissue-based totally restore.
Correct.
It is important to repair the hernia illness at operation to keep away from the risks of early
recurrent intestinal obstruction. With contamination all through the bowel resection, the most
secure option is to carry out a tissue-primarily based repair. Permanent mesh must be
prevented in this example due to the risk of contamination. Use of biologic mesh is
associated with almost certain hernia recurrence. It may be important to carry out the hernia
restore via a separate groin incision.
A 33-yr-old guy has a symptomatic recurrent inguinal hernia following a completely
extraperitoneal (TEP) repair two years ago. Which of the subsequent is the first-class
method for reoperation?
A. TEP restore
B. Trans-belly pre-peritoneal (TAPP) repair
C. Open inguinal restore
D. Open trans-stomach repair - ANSOpen inguinal repair
Correct.
Most specialists could advise an open restore in this situation. It is crucial to avoid using the
equal approach as previously done to limit the threat of nerve damage or other complications
due to scarring. The open inguinal approach is the fine solution. Open trans-stomach repairs
are associated with a better recurrence fee and a repeat TEP or TAPP repair is likely to be
more tough because of scarring.
A vibrant seventy eight-year-old male is referred for control of a proper inguinal hernia
diagnosed by way of his primary care medical doctor in the course of his annual assessment
You are comparing a fifty five-year-old woman for a painful lump in her right groin for several
days. She denies fever, chills, nausea or emesis, has been having ordinary bowel and
bladder characteristic, and is in in any other case terrific health. Physical examination
reveals a solitary three-cm soft, firm, spherical mass in her proper groin under the inguinal
ligament and not using a skin discoloration. She has a pre-paid excursion scheduled in 3
days. At this factor, you would propose:
A. Observation with reevaluation after her excursion
B. Urgent hernia repair
C. Elective hernia repair following her holiday
D. Analgesics and tried reduction of the mass
E. Aspiration of the mass with ultrasound steering - ANSUrgent hernia repair
Correct.
The affected person's records and physical exam are regular with an incarcerated femoral
hernia, which calls for on the spot operation to avoid progression to strangulation, ischemia
and perforation of involved bowel. Complications are highly possibly on this putting. Although
tried reduction underneath analgesia and sedation is affordable, this isn't always endorsed
for femoral hernias. There isn't any function for needle aspiration of a groin mass while a
hernia is suspected.
A healthy forty-12 months-antique man is consulting with you for assessment of intermittent
left groin soreness (4 out of 10 on pain scale) which has been gift for the beyond three
weeks. These symptoms have induced him to miss paintings occasionally. He denies any
constitutional signs, and has no other complaints at this time. On physical examination, you
can't hit upon a hernia, despite provocative maneuvers (i.E., Valsalva, cough). Your advice at
this time would be:
A. Computed tomography (CT) of the stomach and pelvis with oral and intravenous contrast
for further assessment
B. Diagnostic laparoscopy
C. Contrast herniography (peritoneography)
D. Left groin exploration with feasible inguinal hernia repair
E. Ultrasonography of the left groin - ANSUltrasonography of the left groin
Correct.
This patient might also have an occult inguinal hernia which isn't detectable on bodily
examination. Ultrasonography, herniography and CT are all beneficial diagnostic studies,
with ultrasound being the least invasive, less expensive, and with high sensitivity and
specificity. In this affected person with minimum signs, there is no indication for immediate
laparoscopy or groin exploration.
A 60-year-old male affords with persistent pain over his right lower stomach six months after
a bilateral TEPP laparoscopic inguinal hernia restore. There is no evidence of hernia
recurrence, seroma or infection on bodily exam. As a part of your research, you bought a
, undeniable stomach radiograph, which reveals a couple of bilateral spiral tacks throughout
the decrease stomach. You attain the operative file, and affirm your suspicion that the
medical professional used permanent spiral tacks for mesh fixation. Injury to which of the
following nerves is the maximum in all likelihood purpose for his chronic ache?
A. Ilioinguinal nerve
B. Iliohypogastric nerve
C. Genital branch of the genitofemoral nerve
D. Lateral femoral cutaneous nerve
E. Femoral nerve - ANSIliohypogastric nerve
Correct.
Post-herniorrhaphy neuralgia has been pronounced to arise in up to 20% of cases. Injury to
any of the nerves cited can result in publish-herniorrhaphy neuralgia. Given the place of the
affected person's symptoms and the approach used for mesh fixation, the iliohypogastric
nerve is the maximum at risk of injury in the course of laparoscopic mesh fixation.
A 67-yr-old man affords with vomiting and belly distension. An abdominal x-ray
well-knownshows air/fluid tiers suggesting small bowel obstruction. On examination, her
abdomen is distended with diffuse tenderness and there is a soft mass within the right groin.
At operation, you resect a strangulated 6-cm phase of small gut and there is moderate
contamination with bowel contents. What should you do for the hernia?
A. Complete the operation and plan a subsequent hernia restore.
B. Perform a repair the use of polypropylene mesh.
C. Perform a repair the usage of biologic mesh.
D. Perform a tissue-based totally repair. - ANSPerform a tissue-based totally restore.
Correct.
It is important to repair the hernia illness at operation to keep away from the risks of early
recurrent intestinal obstruction. With contamination all through the bowel resection, the most
secure option is to carry out a tissue-primarily based repair. Permanent mesh must be
prevented in this example due to the risk of contamination. Use of biologic mesh is
associated with almost certain hernia recurrence. It may be important to carry out the hernia
restore via a separate groin incision.
A 33-yr-old guy has a symptomatic recurrent inguinal hernia following a completely
extraperitoneal (TEP) repair two years ago. Which of the subsequent is the first-class
method for reoperation?
A. TEP restore
B. Trans-belly pre-peritoneal (TAPP) repair
C. Open inguinal restore
D. Open trans-stomach repair - ANSOpen inguinal repair
Correct.
Most specialists could advise an open restore in this situation. It is crucial to avoid using the
equal approach as previously done to limit the threat of nerve damage or other complications
due to scarring. The open inguinal approach is the fine solution. Open trans-stomach repairs
are associated with a better recurrence fee and a repeat TEP or TAPP repair is likely to be
more tough because of scarring.
A vibrant seventy eight-year-old male is referred for control of a proper inguinal hernia
diagnosed by way of his primary care medical doctor in the course of his annual assessment
