Chapter 13. Abdominal Wall and Hernias
Which of the following is the most common location for recurrence at reoperation following laparoscopic repair of an inguinal hernia?
Answer: C. The most common location for recurrence following laparoscopic hernia repair is the medial aspect of the mesh. This relates to failure to secure the mesh medially and using a piece of mesh that is too small. With a large direct defect, it is important to have adequate coverage anteriorly or the mesh can prolapse into the hernia defect.
A 55-year-old female presents with a tender mass below the inguinal ligament. During repair of the femoral hernia through an inguinal approach, you are unable to reduce the bowel. Which of the following is the next best step?
A. Push up on the bowel inferiorly while pulling up on the bowel superiorly
B. Perform a small segmental bowel resection
C. Divide the inguinal ligament
D. Make a small contralateral inguinal incision to place a laparoscope
Answer: C. If you are unable to reduce the bowel during a femoral hernia repair through an inguinal approach, the next best step is to incise the inguinal ligament. Make sure to control the neck of the hernia so that you can ensure viability of the bowel and then repair the hernia and inguinal ligament.
Which of the following is the most common presentation of an obturator hernia?
D. Paresthesias of the lateral thigh
Answer: A. Obturator hernias are very rare but occur more frequently in multiparous elderly women. They can be associated with the Howship-Romberg sign, which is pain on internal rotation of the thigh. An obturator hernia occurs through a weakened obturator membrane. The defect is usually narrow in diameter, which predisposes to small-bowel incarceration and strangulation.
In which of the following patients is laparoscopic hernia repair indicated?
A. 65-year-old male with bilateral inguinal hernias with a prior radical retropubic prostatectomy
B. 37-year-old pregnant female in the second trimester with an incarcerated left inguinal hernia with a previous caesarean section