ABSITE HERNIA EXAM QUESTIONS AND ANSWERS 100% PASS

ABSITE HERNIA EXAM QUESTIONS AND ANSWERS 100% PASS With dissection of an indirect hernia sac during an open inguinal herniorrhaphy, an unusual rapid oozing began which filled the inguinal canal with bright red blood. The bleeding is coming from the undersurface of the abdominal wall. Which artery is most likely injured? - The inferior epigastric artery arises from the external iliac artery immediately superior to the inguinal ligament, and this is the most likely to be injured during inguinal herniorrhaphy. You are performing a laparoscopic ventral hernia repair on a 32-year-old woman. What is the appropriate amount of mesh overlap on each side during a ventral hernia repair - To decrease the risk of recurrence, there needs to be adequate overlap between the fascia and the abdominal wall. This needs to be balanced by the fact that placing a larger piece of mesh than required increases the amount of prosthetic within the abdomen, which may increase the amount of adhesions or risk of infection. It is believed that an overlap of 3 to 5 cm is ideal for laparoscopic ventral hernia repairs with intraperitoneal placement of mesh. ascites with umbilical hernia - Leaking abdominal ascites is an urgent problem that requires aggressive management, and patients should be immediately admitted to the 2Brittie Donald, All Rights Reserved © 2025 hospital because of the risk of bacterial peritonitis and/or hernia rupture. Emergent repair may be complicated, however. Umbilical hernia repair in cirrhotics with uncontrolled ascites is associated with high mortality (8.3%) and morbidity (16.6%). Attempting to control the ascites prior to repair with aggressive diuresis and sodium and fluid restriction is prudent. Bedrest to remove undue strain on the weak and leaking site as well as administration of intravenous antibiotics to help prevent bacterial peritonitis are also indicated. If operation must be undertaken emergently (true rupture), or diuretic therapy fails to control the ascites, combined umbilical herniorrhapy with a peritoneal-venous shunt is effective in achieving a stable repair with a relatively low morbidity. lumbar hernia of Grynfeltt - Between the latissimus dorsi, the serratus posterior inferior, and the posterior border of the internal oblique lumbar hernia of Petit - Between the latissimus dorsi posteriorly, the iliac crest inferiorly, and the posterior border of the external oblique muscle epigastric hernia - At a defect in the linea alba above the umbilicus spigelian hernia - Between the rectus abdominus medially and the semilunar line laterally through the transversus abdominis aponeurosis female femoral hernia - This patient most likely has a femoral hernia, which is associated with elderly females. The appropriate operation is examination of the 3Brittie Donald, All Rights Reserved © 2025 strangulated bowel, resection of non-viable bowel, and hernia repair, whether performed open or laparoscopically. Simple reduction should not be attempted in this patient with symptoms of bowel obstruction and unknown bowel viability. Femoral hernias occur through the femoral ring (bordered by the superior pubic ramus inferiorly, the femoral vein laterally, and the iliopubic tract laterally) and may continue into the femoral canal, which normally contains only preperitoneal fat and lymph nodes (including Cloquet's). An inguinal approach to femoral hernia repair entails first incising the insertion of the iliopubic tract into Cooper's ligament at the medial margin of the femoral ring, then opening the hernia sac and examining its contents, followed by opening the floor of the inguinal canal. The defect is closed by suturing the iliopubic tract and Cooper's ligament together. The lacunar ligament is the fan-shaped medial portion of the inguinal ligament. Obturator hernias pass through the obturator canal and are associated with the Howship-Romberg sign (inner thigh pain on external rotation of the hip due to obturator nerve irritation). An indirect inguinal hernia is repaired laparoscopically by stapling polypropylene mesh over the defect. The complication of this repair most frequently associated with significant postoperative pain is - Laparoscopic inguinal hernia repair with mesh placement can be separated into two approaches: Totally Extra-Peritoneal (TEP) and Transabdominal Pre-Peritoneal (TAPP). These methods of utilize the pre-peritoneal fascial plane to access the hernia and avoid dividing the muscles of the anterior abdominal wall. Entrapment of the ilioinguinal nerve by mesh is a very common 4Brittie Donald, All Rights Reserved © 2025 complication, resulting in postoperative pain, with majority occurring in open inguinal hernia repairs. In a laparoscopic repair, dissection does not violate the inter-muscular plane through which the ilioinguinal nerve travels. Laparoscopic placement of mesh, however, has the potential to entrap the lateral femoral cutaneous nerve as it exits the peritoneum. Recurrence of the hernia, erosion of the mesh into the intestine (answer A), and formation of a sac hydrocele are all potential complications, but are not frequently associated with significant postoperative pain. Ventral hernia - Given the size of the defect and the fact that it is an incisional hernia repair, the recurrence rate will be substantially lower with the use of prosthetic mesh. If performing a laparoscopic repair with intraperitoneal placement of mesh, a composite mesh should be used to have the visceral side facing the bowel to decrease the risk of adhesions and bowel erosion and the abdominal wall side facing the abdominal wall to promote tissue ingrowth. Additionally, patients wit