Question 6#

Repair of a new 5-cm midline postoperative ventral hernia in an otherwise healthy patient is best accomplished with:

A. Primary suture repair

Postincisional hernias have an unacceptably high incidence of recurrence after primary suture repair. Therefore, a mesh repair, performed either with an open surgical approach or laparoscopic approach, is preferred. Muscle transposition procedures are usually unnecessary in relatively small defects that are not recurrent or related to another abdominal wall defect.

Question 7#

Which of the following statements regarding umbilical hernias is true?

A. Umbilical hernias are present in 10% of all newborns

Umbilical hernias are present in 10% of all newborns, and are more common in premature infants. Most congenital umbilical hernias close spontaneously by 5 years of age, so repair should be delayed until examination shows persistence of the hernia before the child enters school. Adults with small, uncomplicated, unincarcerated umbilical hernias can be followed until symptoms occur.

Question 8#

Spigelian hernias usually occur:

A. On the lateral border of the rectus abdominis muscle

Spigelian hernias can occur anywhere along the length of the Spigelian line or zone-an aponeurotic band of variable width at the lateral border of the rectus abdominis. The most common location of these rare hernias is at the level of the arcuate line. These hernias are not always apparent on physical examination, and may cause local pain or incarceration.

Question 9#

Laparoscopic repair of incisional hernias is associated with which of the following? 

A. Reduced hospital cost

A recent Cochrane database review concluded that shortterm recurrence rates did not differ significantly and laparoscopic repairs were associated with higher in-hospital costs despite generally shorter lengths of stay. The major benefit for laparoscopic repairs compared with open repairs was a consistently lower risk of wound infections.

Question 10#

Which of the following statements about omental infarction are true?

A. Patients usually present with fever and lassitude

Interruption of the blood supply to the omentum is a rare cause of symptoms of an acute abdomen. Depending on the location of the infracted tissue, symptoms may mimic acute appendicitis, acute cholecystitis, acute diverticulitis, or perforated ulcer. The diagnosis is usually inferred from abdominal CT scan which shows a localized inflammatory-appearing mass of the omentum. Surgical resection can hasten recovery, but clinically stable patients can be managed conservatively.