Q: 9 - 11

Q9: Etiol Postop Wound Infection

Rates of infections: CLEAN – 2%, e.g., hernia, breast CLEAN CONTAMINATED – 3% - 5%, e.g., elective

bowel surgery with a prepp. CONTAMINATED – 5% - 10%, e.g., GSW to colon

w/ repair. GROSS CONTAMINAIO – 30% E.g., abscess

>= 10 5 colony forming units = infection

Staph a. – most common skin flora infecton

E. coli – most common GNR

Q10: Nerve Inj. Assoc. LAP Inguinal Hernia Rep.Femoral branch of the genitofemoral nerve are

at risk during laparoscopic inguinal hernia repair

Injury to the lateral cutaneous nerve of the thigh

Q10: Nerve Inj. Assoc. LAP Inguinal Hernia Rep.TRIANGLE OF DOOM: 

Vas deferens medially, Spermatic vessels laterally and External iliac vessels inferiorly. This triangle contains:

External iliac artery and vessels, The deep circumflex iliac vein, The genital branch of genitofemoral nerve and

hidden by fascia the femoral nerve. Staple should not be applied in this triangle

otherwise; chances of mortality are there if these great vessels are injured. 

Q10: Nerve Inj. Assoc. LAP Inguinal Hernia Rep.

TRIANGLE OF PAIN: 

Spermatic vessel medially,

The iliopubic tract laterally and

Inferiorly the inferior edge of skin incision.

This triangle contains:

Lateral femoral cutaneous nerve and

Anterior femoral cutaneous nerve of thigh.

The staple in this area should be less because nerve entrapment can cause neuralgia.

Q11: Rx Crohn’s Dis / Perineal Fistula

About 25 – 43% percent of people with Crohn's disease develop a fistula.

A significant correlation was found between the duration of perianal disease and the development of cancer in a fistula.

If the External opening is anterior to an imaginary line drawn horizontally through the anal canal, the fistula usually runs directly into the anal canal.

If the external opening is posterior to the line, the fistula usually curves to the posterior midline of the anal canal.