MRCS Part A: Essential Revision Notes: Book 2 by Catherine; Chalmers, Claire Ritchie Parchment Smith

By Catherine; Chalmers, Claire Ritchie Parchment Smith

Offers the main up to date fabric, matching the MRCS syllabus, to help coaching for the MRCS A examinations. The publication covers each significant topic within the MRCS syllabus; works systematically via each normal surgical subject more likely to look within the examination; highlights very important rules of surgical procedure; includes very important lists and important issues; is obviously laid out with illustrations to help knowing.

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Extra resources for MRCS Part A: Essential Revision Notes: Book 2

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The base of the superficial ring is the pubic crest. The lacunar ligament forms the medial part of the floor, filling in the angle between the inguinal ligament and the pectineal line. Ceiling of the inguinal canal Lateral to medial, this is formed by transversus abdominis, internal oblique and the conjoint tendon. It arches over the roof of the inguinal canal to become the conjoint tendon. The internal oblique arises in front of the deep ring from the lateral two-thirds of the inguinal ligament and, lying superficial to transversus abdominis, behaves in the same way.

European Hernia Society Guidelines for the Treatment of Inguinal Hernia in Adult Patients (2009) Primary unilateral: mesh repair (Lichtenstein’s or endoscopic repair if expertise is available) Primary bilateral: mesh repair (Lichtenstein’s or endoscopic) Recurrent inguinal hernia: modify technique in relation: • If previously anterior – open preperitoneal mesh or endoscopic approach • If previously posterior – Lichtenstein’s totally extraperitoneal (TEP) is preferred to transabdominal preperitoneal (TAPP) repair in the case of endoscopic surgery Prophylactic antibiotics are not recommended in low-risk patients or in endoscopic surgery Anaesthesia: ASA 1/2: always consider day surgery ASA 3/4: consider local anaesthesia or day surgery Indications for groin hernia repair Repair of inguinal hernia In a nutshell … Main aims of inguinal hernia repair: • Reduce hernia contents • Remove hernia sac • Repair defect Main approaches For primary uncomplicated inguinal hernias: • Lichtenstein’s mesh repair • Laparoscopic repair Other recognised techniques: • Shouldice technique • McVay–Cooper ligament operation Herniotomy for children is a different operation from herniorraphy for adults as there is no need to repair the posterior wall of the inguinal canal in children because there is no defect there.

5) Tubercle of iliac crest: 5 cm behind ASIS at L5. (6) Inguinal ligament: running from ASIS to pubic tubercle. (7) Pubic tubercle: tubercle on superior surface of pubis; inguinal ligament attaches to it, as lateral end of the superficial inguinal ring. (8) Superficial inguinal ring: inguinal hernia comes out above and medial to pubic tubercle at point marked (I); femoral hernia below and lateral to pubic tubercle at point marked (F). (9) Symphysis pubis: midline cartilaginous joint between pubic bones.

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