Exam 13: Hernia Repair

An 86-year-old retired plumber states that he has suffered from a groin hernia all of his adult life; he states,"as far back as I can remember." Sometimes he has to push the bulge back into his abdominal wall and then he is fine until he has a coughing spell.This morning the bulge was large and tender when he woke up,and he could not reduce it.As the pain increased,he felt weak and nauseated.His daughter took him to the emergency department (ED).The patient was diagnosed with a strangulated incarcerated hernia and scheduled for emergency surgery.If the contents of the patient's hernia sac become compromised,with strangulation of the bowel,the probable label on his surgical specimen will be:

Bupivacaine and ropivacaine are look-alike/sound-alike drugs.Adverse drug reactions (ADRs)can occur if a clinician confuses these two drugs.Both drugs promote nerve conduction blockage analgesia when given locally,but bupivacaine is cardiotoxic.When selecting a local anesthetic to fill an elastomeric pain pump,what is one contraindication that should be considered?

Which hernia repair approach(es)use(s)implantable mesh prosthetic?

Laparoscopic inguinal hernia repair is another method of tension-free mesh repair,with several repair options.The most popular techniques include a totally extraperitoneal (TEP)and transabdominal preperitoneal (TAPP)approach.Which of the two techniques provides access to the preperitoneal space without entering the peritoneum?