Surgery MCQ Answer 69

Answer: b

The approach to bilateral groin hernias is based on the extent of the hernia defect. For hernias for which inguinal floor reconstruction is required (all direct and moderate to large indirect inguinal hernias, all femoral hernias), simultaneous repair of bilateral hernia results in recurrence of one or both of the hernias twice as frequently as if the hernias were repaired sequentially. Repair of recurrent inguinal or much less commonly femoral hernias can be repaired via an anterior approach particularly at the time of first recurrence in most cases. If a deficit of aponeurotic tissue exists, methods such as polypropylene mesh as an overlay or preferably as an underlay, and tailored around the spermatic cord have proved highly successful. The preperitoneal approach also has potential benefits especially in cases of multiple recurrence where the technique allows avoidance of the inevitable scar encountered with the anterior approach, excellent assessment of the defect, and the ease for placement of synthetic mesh. The Bassini and Shouldice repairs involve approximation of the medial tissues of the transversus abdominis aponeurosis and transversalis fascia to the inguinal ligament. These techniques cannot be used to repair a femoral hernia because the femoral canal lies deep to the inguinal ligament. Either the anterior approach of McVay (Cooper’s ligament repair) or a preperitoneal approach is preferred for femoral hernias. In patients with bowel obstruction attributed to a hernia, the primary operative approach is on the hernia. Assessment of bowel viability is possible without laparotomy in most cases, and release of adhesions holding the bowel within the sac is more easily accomplished through direct entry into the hernia sac. Reduction of the herniated and incarcerated bowel may be difficult from the intraabdominal approach necessitating a counter incision over the external presentation of the hernia.

Category: Surgery MCQs