Embryology and other stuff
Medial umbilical ligament arise from?
Umbilical arteries
Layers just off the midline and above the umbilicus
ARS
Rectus
PRS
Peritoneum
Direct vs indirect hernia
Direct inferior/medial to the epigastric vessels, passes through superficial ring only
Indirect superior/lateral to epigastric vessels, passes through deep and superficial rings
TEP vs TAPP
Total extraperitoneal repair (peritoneum/abdomen not entered)
Transabdominal preperitoneal repair
Pantaloon hernia
Direct and indirect hernias at same time
Median umbilical ligament arise from?
Urachus
Layers just off midline well below the umbilicus
ARS
Rectus
TF
Peritoneum
Hasselbach's triangle boundaries
rectus muscle, inferior inguinal ligament, inferior epigastric vessels
Triangle of doom border and contents
Vas Deferens and Spermatic vessels
Femoral vessels
Sliding hernia
retroperitoneal organ (colon, bladder) makes up the posterior hernia sac
Meckel's diverticulum arise from?
Omphalomesenteric duct
IO
TA
Inguinal ligament and cremasteric muscles arise from
IO
Triangle of pain border and content
Spermatic vessels, iliopubic tract
femoral nerve, lateral femoral cutaneous, femoral branch of GF
Richter hernia
Common locations for mesh placement
Onlay
Inlay
Sublay (preperitoneal or retromuscular)
Underlay (intraperitoneal)
Blood supply to the rectus and origin of the vessel(s)
Inferior epigastric - external iliac artery
Superior epigastric - internal mammary artery
Spermatic cord structures
testicular artery, pampiniform plexus, cremasteric muscle, vas deferens, ilioinguinal nerve, genital branches the genitofemoral nerve
Potential hernia spaces covered by mesh in laparoscopic inguinal hernia repair
Indirect, direct, and femoral
Inguinal hernia with appendix
Amyand's hernia
Lichtenstein vs Bassini vs McVay
Tension free mesh sewn to the inguinal ligament
Conjoined tendon to the inguinal ligament
Conjoined tendon to Cooper's ligament with transition to inguinal ligament
Layers of abdominal wall if entering at Palmer's point
EO
IO
TA
TF
Peritoneum
Femoral canal boundaries
Posterior - Cooper's ligament
Anterior - Inguinal ligament
Lateral - Femoral vein
Medial - Lacunar ligament
Hard indications of an MIS inguinal hernia repair
Bilateral hernias or recurrent hernia with prior open approach
Spigelian hernia
lateral border of rectus muscle adjacent to the linea semilunaris (usually inferior to arcuate line) defect through some but not all muscular layers (EO usually intact)