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Structure that forms external oblique fascia and shelving edge
External abdominal oblique
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Structure that forms cremasteric muscles
Internal abdominal oblique
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Structure that forms inguinal canal floor
Transversalis muscle
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Structure extending from external abdominal oblique, running from ASIS to pubis
Inguinal ligament
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Where the inguinal ligament splays out to insert in the pubis
Lacunar ligament
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Structure that originates from transversalis, running from ASIS to pubis below inguinal ligament
Ileopubic tract
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Pectineal ligament
Cooper�s ligament
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Aponeurosis of internal oblique and transversus abdominus muscles
Conjoined tendon
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Structure that runs parallel and just medial to cord structures
Vas deferens
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Borders of Hesselbach�s triangle
Rectus muscle, inferior inguinal ligament, inferior epigastrics
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Hernia medial to epigastric vessels
Direct
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Hernia superior/lateral to epigastric vessels
Indirect
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Risk factors for inguinal hernias (9)
Age, obesity, heavy lifting, COPD, constipation, straining, ascites, pregnancy, peritoneal dialysis
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Hernia from persistently patent processus vaginalis
Indirect
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Hernia with higher recurrence rate (between direct and indirect)
Direct
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Hernia with both direct and indirect components
Pantaloon hernia
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Most common structures in sliding hernias (male and female)
Female: ovaries, fallopian tubes. Male: cecum, sigmoid
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Female with an ovary in hernia canal: what do you do?
Ligate round ligament, return ovary to abdomen, biopsy if abnormal
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Open mesh repair that minimizes tissue tension
Lichtenstein repair
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Approximation of conjoined tendon and transversalis fascia superiorly to free edge of inguinal ligament inferiorly
Bassini repair
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Approximation of conjoined tendon and transversalis fascia to Cooper�s ligament. Uses a relaxing incision in external oblique fascia
McVay (Cooper�s ligament repair)
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Indications for lap hernia repair
Bilateral or recurrent
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Most common early complication after hernia repair
Urinary retention
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Morbidity associated with vessel disruption and thrombosis of spermatic cord veins during hernia repair
Testicular atrophy
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Nerve commonly injured following open hernia repair
Ilioinguinal nerve
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Consequences of ilioinguinal nerve damage
Loss of cremasteric reflex, numbness of ipsilateral penis, scrotum and thigh
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Nerve commonly injured following laparoscopic hernia repair
Genitofemoral nerve
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Treatment of cord lipoma
Removal
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Femoral hernia: seen more often in men or women?
Men
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Location of femoral hernia
Medial to femoral vein
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Hernia with characteristic bulge on anterior-medial thigh below inguinal ligament
Femoral
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Hernia along lateral border of rectus muscle, through linea semilunaris
Spigelian hernia
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Hernia with noncircumferential incarceration of bowel wall (knuckle of bowel)
Richter�s hernia
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Hernia with incarcerated Meckel�s
Littre�s hernia
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Inferior lumbar hernia
Petit�s hernia
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Superior lumbar hernia
Grynfelt�s hernia
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Borders of Petit/inferior lumbar hernia (3)
External oblique, lat, iliac crest
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Borders of Grynfelt/superior lumbar hernia (3)
Internal oblique, lumbodorsal aponeurosis, 12th rib
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Inner thigh pain with internal rotation, secondary to obturator hernia
Howship-Romberg sign
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Hernia most likely to recur (among all types)
Incisional
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Morbidity associated with damage to epigastric vessel
Rectus sheath hematoma
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Painless masses, typically found in women, associated with Gardner�s syndrome
Desmoid tumors
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Malignant tumors of mesentery (2)
Liposarcoma, leiomyosarcoma
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Location of malignant mesenteric tumors
Near root of mesentery
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Location of benign mesenteric tumors
Peripheral
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Most common malignant retroperitoneal tumors (2)
Lymphoma, liposarcoma
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5-year survival after resection of retroperitoneal sarcoma
10%
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most common site of metastasis of sarcoma
lungs
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most common omental solid tumor
metastatic disease
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immediate treatment after CO2 embolus
position patient head down turned to left
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first symptom of CO2 embolus
rise in ETCO2, hypotension
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surgical instrument that disrupts H-bonds, causing coagulation
Harmonic
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Surgical instrument with superficial coagulation, and depth of necrosis related to power setting; good for hemostasis of liver and spleen
Argon beam
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Surgical instrument that returns electrons to ground state for energy release as heat; this heat used to coagulate and vaporize
Laser
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Artificial material that allows fibroblast ingrowth
Dacron
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Incidence of vascular or bowel injury with Veress needle or trocar
0.1%
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