When the hernia extends between the layers of abdominal wall muscles and not directly through them, it is called
Which of the following are tension-free inguinal hernia repairs? 1. Stoppa's repair 2. Lichtenstein's repair 3. Laparoscopic TEP repair 4. Desarda's repair.
Anderson-Hynes plasty is a type of repair of
Which surgery is most likely to disturb the paracervical nerve plexus resulting in atonicity of the bladder?
UPSC-CMS 2022 - Surgery UPSC-CMS Practice Questions and MCQs
Question 11: When the hernia extends between the layers of abdominal wall muscles and not directly through them, it is called
- A. Amyand's hernia
- B. Richter's hernia
- C. Littre's hernia
- D. Spigelian hernia (Correct Answer)
Explanation: ***Spigelian hernia*** - A **Spigelian hernia** occurs through a defect in the **Spigelian fascia**, extending between the transverse abdominis and internal oblique muscles. - It typically presents as a bulge between muscular layers, making it often **interparietal** and difficult to diagnose clinically due to its hidden nature. *Amyand's hernia* - This is a rare type of inguinal hernia that contains the **vermiform appendix** within the hernial sac. - It is notable for the potential complication of **appendicitis** within the hernia. *Richter's hernia* - A **Richter's hernia** involves only a portion of the circumference of the bowel wall becoming strangulated within the hernia orifice. - This can lead to **bowel necrosis** without complete obstruction, making diagnosis challenging. *Littre's hernia* - A **Littre's hernia** is characterized by the presence of a **Meckel's diverticulum** within the hernial sac. - It can occur in any hernia type (inguinal, femoral, umbilical) and carries a risk of diverticulitis or perforation.
Question 12: Which of the following are tension-free inguinal hernia repairs? 1. Stoppa's repair 2. Lichtenstein's repair 3. Laparoscopic TEP repair 4. Desarda's repair.
- A. 2, 3 and 4
- B. 1, 3 and 4
- C. 1, 2 and 4
- D. 1, 2 and 3 (Correct Answer)
Explanation: ***1, 2 and 3*** - **Stoppa's repair**, **Lichtenstein's repair**, and **Laparoscopic TEP repair** are all considered tension-free methods because they use mesh to reinforce the inguinal floor without putting tension on the surrounding tissues. - The use of mesh in these repairs distributes the tension across a wider area, minimizing pain and recurrence rates compared to traditional tension-based repairs. - **Desarda's repair** is excluded because it is a tissue-based (non-mesh) technique that uses the external oblique aponeurosis, and is NOT classified as a tension-free repair. *2, 3 and 4* - This option incorrectly excludes **Stoppa's repair**, which is a widely recognized tension-free technique using a large prosthetic mesh in the preperitoneal space. - **Desarda's repair** is incorrectly included as it is a tissue-based repair without mesh, not a tension-free technique. *1, 3 and 4* - This option incorrectly excludes **Lichtenstein's repair**, which is the most commonly performed tension-free open mesh repair for inguinal hernias. - It involves placing a prosthetic mesh over the defect without suturing muscle or fascia under tension. - **Desarda's repair** is incorrectly included as it does not use mesh and is not classified as tension-free. *1, 2 and 4* - This option incorrectly excludes **Laparoscopic TEP repair**, which is a minimally invasive tension-free approach utilizing mesh to reinforce the posterior wall of the inguinal canal in the preperitoneal space. - **Desarda's repair** is incorrectly included; while it aims to be physiological and mesh-free, it is a tissue-based technique and not a tension-free repair.
Question 13: Anderson-Hynes plasty is a type of repair of
- A. lower ureter
- B. ureteropelvic junction (Correct Answer)
- C. glans penis
- D. urinary bladder
Explanation: ***ureteropelvic junction*** - The **Anderson-Hynes pyeloplasty** is a widely used surgical procedure for the correction of a **ureteropelvic junction (UPJ) obstruction**. - It involves **excision of the stenotic or obstructed UPJ segment** and **reconstruction** to create a wide, funnel-shaped connection between the renal pelvis and the ureter. *lower ureter* - Repairs of the lower ureter, such as for distal ureteral strictures or reflux, typically involve procedures like ureteral re-implantation into the bladder or ureteroureterostomy, not the Anderson-Hynes plasty. - While these can address obstruction, the specific technique of Anderson-Hynes is designed for the UPJ. *glans penis* - The glans penis is part of the male external genitalia, and surgical repairs in this area, such as for hypospadias or strictures, are entirely unrelated to the ureter or kidney. - Surgical procedures for the glans penis would involve plastic and reconstructive techniques specific to the urethra and foreskin. *urinary bladder* - Repairs of the urinary bladder involve procedures for conditions like bladder diverticula, fistulae, or augmentation cystoplasty, which are distinct from managing obstructions in the upper urinary tract. - These procedures aim to restore bladder function and integrity, not to address blockages at the junction of the kidney and ureter.
Question 14: Which surgery is most likely to disturb the paracervical nerve plexus resulting in atonicity of the bladder?
- A. Simple hysterectomy
- B. Myomectomy
- C. Vaginal hysterectomy
- D. Radical hysterectomy (Correct Answer)
Explanation: ***Radical hysterectomy*** - This procedure involves extensive dissection around the cervix and upper vagina, increasing the risk of **damage to the paracervical nerve plexus** (Frankenhäuser's plexus). - Damage to this autonomic plexus, which supplies the bladder, can lead to **atonicity** and urinary retention postoperatively due to disrupted innervation. *Simple hysterectomy* - A simple hysterectomy removes the uterus but preserves the parametrial tissues and hence the **paracervical nerve plexus**, minimizing the risk of bladder denervation. - While temporary bladder dysfunction can occur due to local trauma, long-term atonicity is less likely compared to radical procedures. *Myomectomy* - Myomectomy involves the surgical removal of uterine fibroids (myomas) while **preserving the uterus**. - This procedure generally involves minimal dissection in the vicinity of the paracervical nerve plexus, making bladder atonicity an uncommon complication. *Vaginal hysterectomy* - A vaginal hysterectomy removes the uterus through the vagina, with dissection primarily involving the uterosacral and cardinal ligaments. - Although there is some manipulation near the plexus, the **extent of dissection is typically less** than a radical hysterectomy, leading to a lower risk of complete denervation and atonicity.