Chapter 32: Hernias & Other Lesions of the Abdominal Wall

Chapter 32. Hernias & Other Lesions of the Abdominal Wall

The most important principle for successful repair of a groin hernia in an adult is

A. Approximation of the conjoined tendon and inguinal ligament

B. High ligation of the hernia sac

C. A vertical relaxing incision in the anterior rectus sheath

D. A tension free repair

E. Reduction in the size of the internal inguinal ring

D. A tension free repair. A tension free repair is the key factor in successful repair of all groin hernias. Although a tension-free repair can be accomplished by using a relaxing incision in the traditional tissue repairs, the use of mesh for either an open or laparoscopic repair obviates the need for a relaxing incision. Although decreasing the size of the internal ring will help prevent recurrence of an indirect inguinal hernia, it is not sufficient to prevent a recurrence through the transversalis fascia if a strong, tension-free repair is not accomplished.

All of the following are features of a femoral hernia repair except

A. Complete excision of the hernia sac

B. Use of a relaxing incision in the anterior rectus sheath when a tissue repair is done

C. Elimination of the defect in the transversalis fascia

D. Use of Cooper’s ligament or iliopubic tract

E. Use of the inguinal ligament in the repair

E. The use of the inguinal ligament in the repair. Keys to successful repair of a femoral hernia include the knowledge that the femoral canal lies beneath the inguinal ligament. For this reason, the repair must be performed to Cooper’s ligament or the iliopubic tract, which lie deep to the inguinal ligament. The repair must result in obliteration of the hernial defect, whose medial border is the stiff lacunar ligament, superior border is the inguinal ligament, and lateral border is the femoral vein; these structures do not lend themselves to primary repair with sutures. After the contents of the hernia sac are reduced and the sac excised, either mesh or tissue is used to cover the defect in a tension-free manner. If a tissue repair is used, a vertical relaxing incision in the anterior rectus sheath is necessary to prevent tension on the repair. If a laparoscopic or open mesh repair is elected, the defect in the transversalis fascia must be covered completely.

Randomized trials of groin hernia repair show