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Chapter 34. Abdominal Wall Hernias

Of the following open repairs, the most effective method of repairing a femoral hernia is a

A. Lichtenstein repair

B. Lotheissen-McVay repair

C. Bassini repair

D. Shouldice repair

E. Halsted repair

The correct answer is D. Lotheissen-McVay repair. The Lotheissen-McVay repair, which brings the conjoined tendon posteriorly and inferiorly to the Cooper ligament, is the only one of the repairs listed that obliterates the opening through which a femoral hernia travels. Because this repair by its very nature has a greater degree of tension than the other four, it should always be accompanied by a relaxing incision in the anterior rectus sheath.

The least common reason for recurrence of a groin hernia within the first year after repair is

A. Overlooking an indirect hernia sac

B. Tension on the fascial repair

C. A missed femoral hernia

D. Failure to close the fascial defect adequately

E. A defect in collagen synthesis

The correct answer is E. A defect in collagen synthesis. During the first year after repair, a recurrence is most commonly the result of a technical error. The first four options are the most common reasons why early failures occur. Although a defect in collagen may play a role in predisposing someone to develop a hernia in the first place, the mechanical factors listed are overwhelmingly the most common reasons for hernia recurrence early after repair.

The type of open repair of a groin hernia that is both the most commonly performed and also associated with the lowest rate of recurrence is the

A. Shouldice repair

B. Bassini repair

C. Lichtenstein repair

D. Halsted repair

E. Cooper ligament repair

The correct answer is C. Lichtenstein repair. The Lichtenstein repair was developed specifically as a repair that would be associated with less tension on the repair, since tension is one of the major causes of failure of a repair. It is the only one repair listed that employs mesh in the repair. Although the Shouldice repair is reported to have a very low recurrence rate in the hands of those surgeons who employ it, it is far less ...

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