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Chapter 34. Abdominal Wall Hernias
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Of the following open repairs, the most effective method of repairing a femoral hernia is a
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B. Lotheissen-McVay repair
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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.
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The least common reason for recurrence of a groin hernia within the first year after repair is
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A. Overlooking an indirect hernia sac
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B. Tension on the fascial repair
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C. A missed femoral hernia
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D. Failure to close the fascial defect adequately
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E. A defect in collagen synthesis
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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.
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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
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E. Cooper ligament repair
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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 ...