MCQ bank · 37 questions · free
Hernia MCQs with answers
37 single-best-answer questions on inguinal, femoral, umbilical, incisional and emergency hernia repair. Try each one, then open the answer to see the explanation, why the other options are wrong, and the guideline or trial behind it.
A 66-year-old man has a small inguinal hernia that causes him no symptoms. He asks whether he needs an operation. What do you advise?
- Repair is never needed
- A truss as definitive treatment
- Urgent repair because of a high strangulation risk
- CT scan before deciding
- Watchful waiting is a safe option; many men eventually choose repair as symptoms develop
Show the answer and explanation
Answer: E. Watchful waiting is a safe option; many men eventually choose repair as symptoms develop. In men with minimal or no symptoms, watchful waiting is safe because the risk of incarceration is low. However, a large proportion cross over to surgery within a few years as symptoms develop, so repair is also reasonable.
Why not the others? This applies to inguinal hernias in men, not to femoral hernias or to women, who should have repair.
References
A 58-year-old woman has a small, reducible groin lump below and lateral to the pubic tubercle. It is not painful. What is the best plan?
- Repair only if it becomes irreducible
- Prompt elective repair, preferably laparoscopic
- Ultrasound every 6 months
- Watchful waiting
- A truss
Show the answer and explanation
Answer: B. Prompt elective repair, preferably laparoscopic. A lump below and lateral to the pubic tubercle is a femoral hernia, which has a high risk of strangulation, so it should be repaired soon even without symptoms. A laparoendoscopic approach is advised in women because it identifies and repairs occult femoral hernias.
Why not the others? Watchful waiting is only for inguinal hernias in men with few symptoms.
References
A 45-year-old man needs repair of a primary unilateral inguinal hernia. Which approach is recommended as standard?
- Mesh repair: Lichtenstein or laparoendoscopic (TEP or TAPP)
- Primary suture repair of the transversalis fascia only
- Darn repair
- Herniotomy alone
- Bassini tissue repair
Show the answer and explanation
Answer: A. Mesh repair: Lichtenstein or laparoendoscopic (TEP or TAPP). Mesh repair has lower recurrence than tissue repair and is recommended for adult men. Lichtenstein or a laparoendoscopic approach is chosen based on the surgeon’s expertise and patient factors; laparoendoscopic repair has less chronic pain and a faster recovery.
Why not the others? The Shouldice tissue repair is the best non-mesh option in selected cases; Bassini and darn repairs are outdated.
References
You are closing an elective midline laparotomy. Which technique best reduces the risk of a later incisional hernia?
- Closure of all layers including peritoneum separately with non-absorbable suture
- Continuous small-bites closure of the aponeurosis with a slowly absorbable suture, suture length at least 4 times the wound length
- Interrupted mass closure with large bites 2 cm apart
- Skin closure only
- Rapidly absorbable suture in large bites
Show the answer and explanation
Answer: B. Continuous small-bites closure of the aponeurosis with a slowly absorbable suture, suture length at least 4 times the wound length. The STITCH trial showed that small bites (5 mm from the edge, 5 mm apart) with a slowly absorbable suture halved the incisional hernia rate compared with large bites. European and American guidelines recommend this, and suggest prophylactic mesh in high-risk patients.
Why not the others? Large-bite techniques have higher hernia rates.
References
A 70-year-old man has a painful, irreducible right inguinal hernia for 10 hours, with vomiting, a tender red lump and a raised lactate. What is the management?
- Ultrasound and outpatient review
- Analgesia and observation overnight
- Emergency surgery, assessing the bowel for viability
- Trendelenburg position and ice packs, then discharge
- Manual reduction under sedation and elective repair later
Show the answer and explanation
Answer: C. Emergency surgery, assessing the bowel for viability. Signs of strangulation (constant pain, tenderness, skin changes, systemic upset or raised lactate) mean the blood supply of the contents may be compromised. These patients need emergency surgery. Attempted reduction can push dead bowel back into the abdomen.
Why not the others? Gentle reduction is considered only for a recently incarcerated hernia with no signs of strangulation.
References
- Birindelli A et al. 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias. World J Emerg Surg 2017
- Stabilini C et al. Update of the international HerniaSurge guidelines for groin hernia management. BJS Open 2023
- HerniaSurge Group. International guidelines for groin hernia management. Hernia 2018
A 45-year-old man has a symptomatic primary umbilical hernia with a 2-cm defect. Which repair is recommended?
- Watchful waiting is the only option
- Mesh repair, typically an open preperitoneal flat mesh
- Simple suture repair
- Mayo “vest over pants” repair
- Intraperitoneal mesh by laparoscopy for every small hernia
Show the answer and explanation
Answer: B. Mesh repair, typically an open preperitoneal flat mesh. For umbilical and epigastric hernias with a defect of 1 cm or more, mesh reduces recurrence compared with suture repair. An open preperitoneal flat mesh is suggested for most small defects; laparoscopic repair is considered for larger defects or patients with obesity.
Why not the others? Suture repair has higher recurrence; it may be acceptable for very small (<1 cm) defects.
References
A healthy 2-year-old has a soft, painless 1-cm umbilical hernia that reduces easily. The parents ask about surgery. What do you advise?
- Strapping a coin over the umbilicus
- Ultrasound every 6 months
- Repair before age 3 in every case
- Urgent repair because of the risk of strangulation
- Observation; most close on their own, and repair is considered if it persists beyond about 4–5 years of age
Show the answer and explanation
Answer: E. Observation; most close on their own, and repair is considered if it persists beyond about 4–5 years of age. Most childhood umbilical hernias close spontaneously, and complications are rare. Repair is usually offered if the hernia persists after 4–5 years of age, or earlier if it is very large or causes symptoms.
Why not the others? This is the opposite of a childhood inguinal hernia, which should be repaired soon after diagnosis because incarceration is common. Strapping does not help and can irritate the skin.
References
Eight months after her second pregnancy, a 32-year-old woman has a midline bulge from the xiphoid to the umbilicus when she sits up. Ultrasound shows a 3-cm separation of the rectus muscles with no hernia. What do you advise first?
- Explain that this is rectus diastasis, not a hernia, and refer for supervised core physiotherapy
- CT to plan surgery
- Laparoscopic intraperitoneal mesh repair
- Advise her to avoid all exercise
- Urgent mesh repair
Show the answer and explanation
Answer: A. Explain that this is rectus diastasis, not a hernia, and refer for supervised core physiotherapy. Rectus diastasis is widening of the linea alba without a fascial defect, so there is no risk of strangulation. Physiotherapy is first-line. Surgery (plication) is considered only for persistent symptoms or when there is an associated hernia, ideally once further pregnancies are complete.
Why not the others? There is no hernia to repair, and exercise guided by a physiotherapist is helpful.
References
A 56-year-old man wants elective repair of an 8-cm incisional hernia. He smokes 20 cigarettes a day and his BMI is 44. The hernia is not painful and has never been stuck. What do you advise first?
- Never operate on smokers
- Repair next week as planned
- Emergency repair to prevent strangulation
- Optimise before surgery: stop smoking for at least 4 weeks and lose weight, then repair
- Repair only once he reaches a BMI of 25
Show the answer and explanation
Answer: D. Optimise before surgery: stop smoking for at least 4 weeks and lose weight, then repair. Smoking and severe obesity sharply increase wound infection, mesh infection and recurrence after ventral hernia repair. For an asymptomatic hernia, there is time to optimise: stopping smoking at least 4 weeks before surgery, weight loss (ideally to a BMI below about 35–40), and good glucose control. Bariatric surgery first is an option for some patients.
Why not the others? Optimisation is a delay, not a refusal; emergency signs change the plan at any time.
References
You are performing an open elective repair of a 7-cm midline incisional hernia. Where is the mesh best placed?
- Bridging the defect without closing it (inlay)
- In the retromuscular (sublay) position, behind the rectus muscles
- No mesh; simple suture repair
- Only an onlay mesh, always
- Directly on the skin
Show the answer and explanation
Answer: B. In the retromuscular (sublay) position, behind the rectus muscles. For open repair, retromuscular (sublay) mesh with closure of the linea alba is associated with the lowest recurrence and fewer wound problems than onlay or inlay. Suture repair alone has high recurrence for defects of this size.
Why not the others? Bridging an open defect with mesh (inlay) has the highest recurrence and is avoided.
References
A thin 84-year-old woman has 2 days of vomiting and colicky abdominal pain. She has pain along the inner thigh that is worse when the hip is extended and rotated. She has no previous surgery and no visible hernia. What is the likely diagnosis and test?
- Femoral hernia; no imaging needed
- Sciatica; MRI of the spine
- Gastroenteritis; stool culture
- Hip arthritis; hip X-ray
- Obturator hernia; CT of the abdomen and pelvis
Show the answer and explanation
Answer: E. Obturator hernia; CT of the abdomen and pelvis. Obturator hernia typically affects thin, elderly women and presents as small bowel obstruction without a visible lump. Pain along the medial thigh from compression of the obturator nerve (Howship–Romberg sign) is a clue. CT confirms the diagnosis, and surgery is needed, often with bowel resection because diagnosis is late.
Why not the others? Thinking “no scars, no lump, so no hernia” is a classic trap in elderly women with obstruction.
References
Six months after a Lichtenstein inguinal hernia repair, a man has burning groin pain radiating to the scrotum that limits daily activity. There is no recurrence on examination or ultrasound. What is the first step?
- Re-repair of the hernia
- Multimodal conservative treatment (analgesia, neuropathic agents, nerve blocks) and referral to a specialist pain or hernia team
- Long-term opioids only
- Reassurance that it will always settle
- Immediate removal of the mesh
Show the answer and explanation
Answer: B. Multimodal conservative treatment (analgesia, neuropathic agents, nerve blocks) and referral to a specialist pain or hernia team. Chronic postoperative inguinal pain is pain lasting beyond 3 months. It is first managed conservatively with multimodal analgesia and diagnostic or therapeutic nerve blocks. If pain persists, a specialist may offer surgery (for example triple neurectomy with or without mesh removal).
Why not the others? Operating without a structured assessment rarely helps, and long-term opioids are not the solution.
References
A 50-year-old man has symptomatic bilateral inguinal hernias. Which approach is recommended?
- A laparoendoscopic repair (TEP or TAPP), repairing both sides through the same small incisions
- Two separate open operations months apart
- Herniotomy only
- Open Bassini repair on both sides
- Watchful waiting is required for bilateral hernias
Show the answer and explanation
Answer: A. A laparoendoscopic repair (TEP or TAPP), repairing both sides through the same small incisions. For bilateral inguinal hernias, laparoendoscopic repair allows both sides to be repaired at once through the same access, with less pain and a faster return to activity, provided the surgeon has the expertise.
Why not the others? Open repair of both sides at once is possible but more painful.
References
A 60-year-old man has a recurrent inguinal hernia after a previous open Lichtenstein mesh repair. Which approach is recommended?
- A posterior (laparoendoscopic) repair, through the unscarred plane
- Tissue repair without mesh
- Herniotomy only
- Another open anterior repair through the same scar
- Watchful waiting is mandatory
Show the answer and explanation
Answer: A. A posterior (laparoendoscopic) repair, through the unscarred plane. After a failed anterior repair, the posterior (preperitoneal) approach goes through tissue that has not been operated on, which is easier and has lower recurrence and nerve injury. Conversely, after a failed posterior repair, an anterior Lichtenstein repair is preferred.
Why not the others? Re-operating through scar tissue increases the risk of injury to the cord and nerves.
References
An 80-year-old woman has a painful, irreducible lump below the inguinal ligament for 2 days. She has no vomiting and is passing stool and flatus. What important possibility explains the lack of obstruction?
- Strangulation is impossible without vomiting
- It must be a lymph node
- A lipoma never needs surgery
- A Richter’s hernia, in which only part of the bowel wall is trapped, so the lumen stays open but the wall can still strangulate
- Obstruction is required for a hernia diagnosis
Show the answer and explanation
Answer: D. A Richter’s hernia, in which only part of the bowel wall is trapped, so the lumen stays open but the wall can still strangulate. In a Richter’s hernia, the antimesenteric wall of the bowel is trapped, often in a narrow femoral canal. Bowel obstruction may be absent or partial, but the trapped wall can necrose and perforate. An irreducible, tender femoral lump needs urgent surgery.
Why not the others? Normal bowel function does not exclude strangulation of part of the bowel wall.
References
A 68-year-old with an end colostomy has a large, symptomatic parastomal hernia that makes his appliance leak. Which statement is correct?
- Moving the stoma is always the first choice
- Suture repair of the fascia is the gold standard
- Repair should be done only in an emergency
- Parastomal hernias never need repair
- Repair is offered for symptoms, and mesh repair is recommended because suture repair has a very high recurrence
Show the answer and explanation
Answer: E. Repair is offered for symptoms, and mesh repair is recommended because suture repair has a very high recurrence. Parastomal hernias are very common. Symptomatic hernias (pain, leaking, obstruction) are repaired using mesh, for example with a Sugarbaker or keyhole technique, laparoscopically or open. Primary suture repair has unacceptable recurrence rates.
Why not the others? Asymptomatic hernias can be managed with a support belt.
References
A man with cirrhosis and ascites has an umbilical hernia. The skin over it has become thin and is now leaking ascitic fluid. What is the plan?
- Repair is contraindicated in cirrhosis
- Urgent repair, with control of the ascites and involvement of the hepatology team
- Large-volume paracentesis alone and discharge
- A dressing and review in 3 months
- Observation until the leak stops
Show the answer and explanation
Answer: B. Urgent repair, with control of the ascites and involvement of the hepatology team. Leakage of ascites through thin skin risks rupture, peritonitis and death, so it needs urgent repair. Elective repair is also reasonable in well-compensated patients once ascites is controlled, because emergency complications are more dangerous than elective surgery.
Why not the others? Waiting allows rupture and infection.
References
During an emergency repair of an incarcerated incisional hernia, you resect 20 cm of ischaemic small bowel without gross spillage. What do you do about the hernia defect?
- Leave the abdomen open in every case
- Mesh can never be used after bowel resection
- A synthetic mesh may be used in this clean-contaminated field; with gross contamination, a permanent synthetic mesh is avoided
- Use a large onlay mesh in the presence of faecal peritonitis
- Close the skin only
Show the answer and explanation
Answer: C. A synthetic mesh may be used in this clean-contaminated field; with gross contamination, a permanent synthetic mesh is avoided. Evidence suggests that synthetic mesh can be used in clean-contaminated emergency hernia repair (bowel opened without gross spillage) with acceptable infection rates and lower recurrence. In contaminated or dirty fields, alternatives include primary repair, a biological or biosynthetic mesh, or delayed repair.
Why not the others? Faecal contamination is a contraindication to placing a permanent synthetic mesh.
References
A 30-year-old woman who is 20 weeks pregnant has a painless, reducible umbilical hernia. What do you advise?
- Strapping a coin over the hernia
- Elective mesh repair now
- Watchful waiting during pregnancy, with repair after delivery if needed; emergency repair only for complications
- Caesarean section to allow repair
- Termination is required
Show the answer and explanation
Answer: C. Watchful waiting during pregnancy, with repair after delivery if needed; emergency repair only for complications. Elective repair is postponed during pregnancy because complications are rare, and repair after delivery (and preferably after planned pregnancies) has a lower recurrence. Incarceration or strangulation still needs emergency surgery.
Why not the others? Repairing an uncomplicated hernia during pregnancy adds risk without benefit.
References
An 82-year-old man with heart failure (ASA III) needs repair of a symptomatic primary inguinal hernia. Which anaesthetic approach is recommended for an open repair?
- Local anaesthesia, which is safe and associated with fewer complications in patients with significant comorbidity
- Repair is not possible in ASA III patients
- Spinal anaesthesia is always preferred
- General anaesthesia is always required
- Sedation without local anaesthetic
Show the answer and explanation
Answer: A. Local anaesthesia, which is safe and associated with fewer complications in patients with significant comorbidity. Open inguinal hernia repair under local anaesthesia is recommended, particularly for older patients and those with significant comorbidity. It reduces urinary retention, cardiopulmonary complications and cost, and allows day-case surgery. Laparoendoscopic repair requires general anaesthesia.
Why not the others? Spinal anaesthesia increases urinary retention.
References
A 45-year-old man is having a TEP repair of a primary 2-cm lateral (indirect) inguinal hernia. Is mesh fixation needed?
- Always with sutures through the skin
- Always with many tacks
- Only glue for all cases
- Not routinely; fixation can be omitted in most TEP repairs, but is considered for large medial (direct) defects
- Mesh is not used in TEP
Show the answer and explanation
Answer: D. Not routinely; fixation can be omitted in most TEP repairs, but is considered for large medial (direct) defects. In TEP, the mesh is held by intra-abdominal pressure in the preperitoneal space. Avoiding tacks may reduce postoperative pain without increasing recurrence. Fixation is suggested for large direct defects, where recurrence risk is higher.
Why not the others? Tacks placed in the “triangle of pain” or “triangle of doom” can cause nerve or vascular injury.
References
A 24-year-old footballer has groin pain on kicking and sprinting for 4 months. Examination shows tenderness at the pubic tubercle and no palpable hernia. What is the first-line treatment?
- Steroid injections into the testis
- Immediate mesh hernia repair
- Antibiotics
- Structured physiotherapy and rehabilitation for athletic groin pain (inguinal-related groin pain)
- Complete rest for 1 year
Show the answer and explanation
Answer: D. Structured physiotherapy and rehabilitation for athletic groin pain (inguinal-related groin pain). Athletic groin pain is classified by the Doha agreement (adductor-, iliopsoas-, inguinal- or pubic-related). Most improve with targeted rehabilitation. Surgery is considered for inguinal-related pain that persists despite good rehabilitation.
Why not the others? There is no hernia to repair initially; imaging helps exclude other causes.
References
At the end of a laparoscopic cholecystectomy, how should port sites be closed to reduce port-site hernia?
- Close only the skin
- Close only the 5-mm ports
- No fascial closure needed for any port
- Close the fascia at ports of 10 mm or more, especially at the umbilicus
- Leave the umbilical port open to drain
Show the answer and explanation
Answer: D. Close the fascia at ports of 10 mm or more, especially at the umbilicus. Trocar-site hernias are most common at umbilical and larger (10 mm or more) ports. Fascial closure of these sites is recommended. Smaller 5-mm ports rarely need closure.
Why not the others? Port-site hernias can cause small bowel obstruction, including Richter’s type.
References
A 70-year-old with a BMI of 33 is having an open repair of an abdominal aortic aneurysm through a midline incision. What can reduce his risk of incisional hernia?
- Large-bites closure with rapidly absorbable suture
- Small-bites closure and a prophylactic mesh (for example onlay or retromuscular)
- Bed rest for 3 months
- Avoid closing the fascia
- An abdominal binder alone
Show the answer and explanation
Answer: B. Small-bites closure and a prophylactic mesh (for example onlay or retromuscular). Patients with AAA and those with obesity have a high incidence of incisional hernia after midline laparotomy. Trials (such as PRIMA) show prophylactic mesh reduces this risk, and guidelines suggest considering it in high-risk elective patients, combined with small-bites closure.
Why not the others? Binders do not prevent incisional hernia.
References
Ten days after a TEP inguinal hernia repair, a man has a soft, non-tender swelling in the groin, similar to the hernia. Ultrasound shows a fluid collection. What is the management?
- Reassurance; a seroma usually resolves within weeks, and aspiration is not routinely needed
- Immediate re-operation
- Antibiotics
- Remove the mesh
- Repeated aspiration every week
Show the answer and explanation
Answer: A. Reassurance; a seroma usually resolves within weeks, and aspiration is not routinely needed. Seromas are common after laparoendoscopic repair, especially for large direct hernias, and usually resolve without treatment. Aspiration risks introducing infection into the mesh space. Patients should be warned beforehand so they do not think the hernia has recurred.
Why not the others? Aspiration is reserved for symptomatic, persistent seromas.
References
A 45-year-old woman has a symptomatic primary inguinal hernia. Which repair is recommended?
- Herniotomy without mesh
- Lichtenstein repair is the only option
- Laparoendoscopic repair (TEP or TAPP), which also detects and repairs an occult femoral hernia
- Open Bassini repair
- Watchful waiting
Show the answer and explanation
Answer: C. Laparoendoscopic repair (TEP or TAPP), which also detects and repairs an occult femoral hernia. Women have a higher rate of femoral hernia and of recurrence as femoral hernia after anterior inguinal repair. A laparoendoscopic approach covers both the inguinal and femoral openings, so it is recommended for women with groin hernias.
Why not the others? Watchful waiting is not recommended for women because of the femoral hernia risk.
References
During a Lichtenstein inguinal hernia repair, which step reduces the risk of chronic postoperative pain?
- Avoiding local anaesthetic
- Identifying and protecting the ilioinguinal, iliohypogastric and genital branch of the genitofemoral nerves
- Tight mesh placement under tension
- Routinely cutting all three nerves
- Using as many sutures as possible near the nerves
Show the answer and explanation
Answer: B. Identifying and protecting the ilioinguinal, iliohypogastric and genital branch of the genitofemoral nerves. Chronic pain after open repair is often neuropathic. Careful identification and handling of the three nerves, avoiding entrapment by sutures or mesh, reduces the risk. If a nerve is at risk of entrapment, a planned division (pragmatic neurectomy) may be considered.
Why not the others? Routinely dividing all nerves causes numbness and does not reliably prevent pain.
References
According to the European Hernia Society classification, how is a midline incisional hernia with a 7-cm wide defect described?
- W3 (over 10 cm)
- W1 (under 4 cm)
- Width is not part of the classification
- W0
- W2 (width 4–10 cm)
Show the answer and explanation
Answer: E. W2 (width 4–10 cm). The EHS classification describes incisional hernias by location (midline or lateral) and width: W1 under 4 cm, W2 4–10 cm, W3 over 10 cm. Width helps choose the repair technique and compare outcomes.
Why not the others? Recurrent hernias are also recorded separately.
References
A 60-year-old has intermittent pain lateral to the lower rectus muscle, below the umbilicus, with a vague tender swelling. There is no obvious lump on standing. Ultrasound shows a defect along the semilunar line. What is it, and what is advised?
- Rectus sheath haematoma; anticoagulation
- A lipoma; observation
- A Spigelian hernia; repair, because the narrow neck carries a significant risk of incarceration
- Appendicitis; antibiotics
- An inguinal hernia; watchful waiting
Show the answer and explanation
Answer: C. A Spigelian hernia; repair, because the narrow neck carries a significant risk of incarceration. Spigelian hernias occur through the Spigelian aponeurosis, usually below the arcuate line, and often lie beneath the external oblique, so they can be hard to feel. Ultrasound or CT helps. Their narrow neck means they should be repaired, often laparoscopically.
Why not the others? The hernia sac may be hidden under the intact external oblique.
References
A patient has a 14-cm wide midline incisional hernia, and the rectus muscles cannot be brought together. Which technique allows closure of the linea alba with a retromuscular mesh?
- Skin closure only
- Leaving the hernia open
- Simple suture repair under tension
- Posterior component separation, such as transversus abdominis release (TAR)
- Bridging onlay mesh without closure only
Show the answer and explanation
Answer: D. Posterior component separation, such as transversus abdominis release (TAR). Component separation releases layers of the abdominal wall to bring the rectus muscles to the midline. Transversus abdominis release creates a large retromuscular space for mesh. Patients are optimised before surgery, sometimes with botulinum toxin injection.
Why not the others? Tension repairs of large defects fail.
References
A patient is having closure of a loop ileostomy. Which measure reduced incisional hernia at the stoma site in the ROCSS trial?
- Reinforcement of the stoma closure site with a biological mesh
- Using a larger incision
- Placing a drain
- Avoiding closure of the skin
- Leaving the fascia open
Show the answer and explanation
Answer: A. Reinforcement of the stoma closure site with a biological mesh. Incisional hernias are common after stoma closure. The ROCSS trial showed that reinforcing the closure with a biological mesh reduced hernia rates without increasing wound complications, although cost and availability limit its use.
Why not the others? Mesh choice and cost must be considered.
References
A healthy 40-year-old is having an open Lichtenstein mesh repair in a hospital with a low surgical site infection rate. Are prophylactic antibiotics needed?
- Yes; intravenous vancomycin for everyone
- Yes; 7 days of oral antibiotics
- Not routinely; HerniaSurge does not recommend prophylaxis for low-risk patients in low-risk settings
- Only antifungals
- Yes; antibiotics for 1 month
Show the answer and explanation
Answer: C. Not routinely; HerniaSurge does not recommend prophylaxis for low-risk patients in low-risk settings. In low-risk patients having open mesh repair in centres with low infection rates, antibiotic prophylaxis does not significantly reduce infection. It is recommended for patients with risk factors (recurrence, diabetes, immunosuppression, long operations) or in high-risk settings.
Why not the others? Laparoendoscopic repairs have very low infection rates.
References
Which statement about the setting for elective inguinal hernia repair is correct?
- Day surgery is only for patients under 40
- Most patients, including many older patients, can have it as day-case surgery
- It must be done under general anaesthesia with overnight stay
- All patients need 3 nights in hospital
- It requires intensive care afterwards
Show the answer and explanation
Answer: B. Most patients, including many older patients, can have it as day-case surgery. Elective inguinal hernia repair is well suited to day surgery, whether open under local anaesthesia or laparoendoscopic. Day surgery is safe, cost-effective and preferred by most patients, provided there is adequate support at home.
Why not the others? Social support and comorbidity, rather than age alone, determine suitability.
References
A 38-year-old has groin pain on straining and a history suggestive of a hernia, but no lump is felt on examination. What is the first imaging test?
- Diagnostic laparoscopy as first test
- Dynamic ultrasound (with Valsalva); MRI if ultrasound is negative and doubt remains
- Plain X-ray
- No imaging; operate
- Herniography as first choice
Show the answer and explanation
Answer: B. Dynamic ultrasound (with Valsalva); MRI if ultrasound is negative and doubt remains. When a hernia is suspected but not palpable, dynamic ultrasound is the first test. If it is negative or inconclusive, MRI can show an occult hernia and other causes of groin pain. Imaging is not needed when a hernia is clearly palpable.
Why not the others? Operating without evidence of a hernia risks persistent pain.
References
A 75-year-old has a very large inguinoscrotal hernia that extends to the bottom of the scrotum and cannot be fully reduced. Which statement is correct?
- An open (Lichtenstein) repair is often preferred, with laparoendoscopic repair reserved for surgeons with specific expertise; a risk of loss of domain and scrotal haematoma should be discussed
- Watchful waiting is always best
- Laparoscopy is mandatory for all inguinoscrotal hernias
- Herniotomy without mesh
- Orchidectomy is always needed
Show the answer and explanation
Answer: A. An open (Lichtenstein) repair is often preferred, with laparoendoscopic repair reserved for surgeons with specific expertise; a risk of loss of domain and scrotal haematoma should be discussed. Large inguinoscrotal hernias are technically challenging laparoscopically. Open repair allows controlled reduction and handling of the large sac. Large irreducible hernias can cause loss of domain, so the abdominal capacity may need to be considered.
Why not the others? Routine orchidectomy is not necessary.
References
During emergency repair of a strangulated femoral hernia, you resect necrotic small bowel and there is gross contamination. How do you repair the femoral defect?
- A large synthetic mesh plug
- A tissue repair, such as a McVay (Cooper’s ligament) or simple suture closure of the femoral canal, avoiding permanent synthetic mesh in a contaminated field
- Lichtenstein repair
- Leave the defect open
- No repair is needed
Show the answer and explanation
Answer: B. A tissue repair, such as a McVay (Cooper’s ligament) or simple suture closure of the femoral canal, avoiding permanent synthetic mesh in a contaminated field. In a heavily contaminated field, a permanent synthetic mesh carries a high risk of infection. The femoral canal can be closed by suturing the inguinal (or iliopubic tract) to Cooper’s ligament. The McVay repair also reconstructs the inguinal floor.
Why not the others? Lichtenstein repair does not close the femoral canal.
References
Months after a laparoscopic inguinal hernia repair, a man has a firm, tender lump and pain in the groin. There is no recurrence. Imaging shows a folded, crumpled mesh. What is the likely diagnosis?
- Recurrent hernia
- Testicular tumour
- Lymphoma
- Meshoma (a folded or migrated mesh), which may require mesh removal if pain persists
- Normal postoperative appearance
Show the answer and explanation
Answer: D. Meshoma (a folded or migrated mesh), which may require mesh removal if pain persists. A meshoma is a mass of crumpled mesh, often from poor flattening or migration, causing pain or a palpable lump. It is one cause of chronic postoperative inguinal pain. Imaging confirms it, and surgical removal by an experienced surgeon may be needed if conservative treatment fails.
Why not the others? Good mesh placement with adequate overlap and dissection reduces this risk.
References