SAGES Web Quiz #8 -- December 1998

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Question 1: This is a laparoscopic view in an elderly gentleman with a reducible bulge in his left groin. Using the Nyhus Classification, this inguinal hernia is:

[] (a) Type I
[] (b) Type II
[] (c) Type IIIA
[] (d) Type IIIB
[] (e) Type IIIC
[] (f) Don't Know

Question 2: A transabdominal preperitoneal (TAPP) repair is being used. To avoid bladder injury, the peritoneum Is opened lateral to:

[] (a) the inferior epigastric vessels
[] (b) the median umbilical ligament
[] (c) the medial umbilical ligament
[] (d) the lateral umbilical ligament
[] (e) the anterior superior iliac spine
[] (f) Don't Know

Question 3: This right side TAPP repair shows Cooper's ligament (or the lacunar ligament,) a standard landmark for orientation and fixation. Bleeding can occur from stapling to it if the surgeon does not recognize:

[] (a) the femoral vein
[] (b) the femoral artery
[] (c) the inferior epigastric artery
[] (d) the external spermatic (or cremasteric) artery
[] (e) an aberrant obturator artery
[] (f) Don't Know

Question 4: A left sided TAPP repair with a large anchored mesh covering the entire myopectineal orifice of Fruchaud. Staples in the lower left-hand part of the screen (beneath the inguinal ligament) could entrap :

[] (a) the lateral femoral cutaneous nerve
[] (b) the iliohypogastric nerve
[] (c) the femoral nerve
[] (d) b and c
[] (e) a and c
[] (f) Don't Know

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