UPSC-CMS 2022 - Surgery Practice Questions

Q: When the hernia extends between the layers of abdominal wall muscles and not directly through them, it is called

Spigelian hernia. ***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.

Q: 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.

1, 2 and 3. ***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.

Q: Anderson-Hynes plasty is a type of repair of

ureteropelvic junction. ***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.

Q: Which surgery is most likely to disturb the paracervical nerve plexus resulting in atonicity of the bladder?

Radical hysterectomy. ***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.

Question 1

When the hernia extends between the layers of abdominal wall muscles and not directly through them, it is called

Accepted Answer

Spigelian hernia

Answer

Amyand's hernia

Answer

Richter's hernia

Answer

Littre's hernia

Question 2

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.

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 4

Question 3

Anderson-Hynes plasty is a type of repair of

Accepted Answer

ureteropelvic junction

Answer

lower ureter

Answer

glans penis

Answer

urinary bladder

Question 4

Which surgery is most likely to disturb the paracervical nerve plexus resulting in atonicity of the bladder?

Accepted Answer

Radical hysterectomy

Answer

Simple hysterectomy

Answer

Myomectomy

Answer

Vaginal hysterectomy

UPSC-CMS 2022 — Surgery