This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
[{'content': 'All of the following statements are true about the repair of groin hernias except - \nSelect and explain. \nA. Lichtenstein tension free repair has a low recurrence rate, B. TEP repair is an extraperitoneal approach to laparoscopic repair of groin hernia, C. In Shouldice repair, non-abosorbable mesh is used, D. The surgery can be done under local anaesthesia in selected cases.', 'role': 'user'}, {'content': "Answer: C \nExplanation: Shouldice repair is a method of hernia repair in which the inguinal floor is strengthened by just approximation of tissue using non-absorbable sutures. No mesh is used.\n\n\nManagement of Groin hernias (mainly inguinal hernia)\xa0 \nThere are 2 objectives of t/t :\nTreatment of the hernial sac\nIn Indirect hernias, the sac is dissected free from the cord structures and cremastric fibres. The sac is opened and the herniated contents are reduced. Then the sac is ligated at the internal inguinal ring. Alternatively the hernial sac may be invaginated back into the abdomen without ligation.\nDirect sacs are usually too broad based for ligation and should not be opened but instead are simply inverted into the peritoneal cavity.\nInguinal floor reconstruction\n\nManagement of the hernial sac is sufficient for children and young adults, but some method of reconstruction (repair or strengthening) of the inguinal floor is necessary for all adult hernias to prevent recurrence.\n3 broad categories of repair are available\n\n\nPrimary tissue repair\nAnterior tension-free mesh repairs\nPreperitoneal repairs - open & the laparoscopic approach\n\na) Primary tissue repair\n\nIn this method, the post wall of inguinal canal is strengthened by just approximation of tissues with sutures. There is no use of any prosthetic material.\nPrimary repairs without mesh were the mainstay of hernia surgery for decades. The advantages are simplicity of the repair and absence of any foreign body in the groin. Disadvantages include higher recurrence rates due to tension on the repair and a slower return to unrestricted physical activity. Consequently, tension free mesh repairs have now become the dominant method of inguinal hernia repair.\nCommonly performed primary tissue repairs are\n\n\nBassini repair\nHalsted repair\nMcVay (Cooper ligament) repair\nShouldice repair\nDarn repair\n\n\nDarn repair gets its name from the way a long nylon suture repeatedly passed between the tissues to create a weave that one might consider similar to mesh.\n\nAnterior tension-free mesh repair\nRecognizing that tension in a repair is the principal cause of recurrence, current practices in hernia management employ a synthetic mesh prosthesis to bridge the defect\n\nRecurrence rate is quite low with these techniques\nCommon employed techniques are\n\n\xa0Lichtenstein repair\nIn Lichtenstein repair a piece of polypropylene mesh is used to reconstruct the inguinal floor.\n\nThe mesh is sutured to the abdominal fascia.\nRecurrence rate is quite low\n\nPatch and plug technique\nIn this method, a plug of the mesh is inserted into the hernial defect (i.e. an internal ring in an Indirect hernia) and sutured in place. Then another piece of mesh is placed over the inguinal floor which may or may not be sutured to the fascia.\nLaparoscopic and Preperitoneal repairs\n\nThe laparoscopic hernia repair is based on the technique of 'Stoppa', who used an open preperitoneal approach to reduce the hernia and placed a large piece of mesh to cover the entire inguinal floor and myopectineal orifice. Preperitoneal hernia repairs may also be performed without mesh, but its rarely used now.\nIn Laparoscopic hernia repair, the preperitoneal space is reached by either transabdominal laparoscopy (TAPP) or by a totally extraperitoneal repair (TEP)\nBoth techniques are similar in actual repair but differ in the manner by which the preperitoneal space is accessed.\n\nTAPP (Trans-abdominal pre-peritoneal)\n\nin the TAPP repair, the peritoneal space is entered by conventional laparoscopy and then the preperitoneum overlying the inguinal floor is dissected away as a flap.\n\nTEP (totally extraperitoneal repair)\n\nin TEP repair the preperitoneal space is accessed without entering the peritoneal cavity.\n\nChoice of Anesthesia\n\n\nHere there is a difference of opinion b/w Schwartz Surgery (8/e, p 1368) & Washington Manual of Surgery (4/e, p 511)\n\nAccording to the Washington Manual of Surgery\n\nlocal anaesthesia is the preferred anaesthetic for elective open repair.\nLaparoscopic hernia repair has been carried out under local or regional anaesthesia, but is more commonly done under General anaesthesia.\n\nAccording to Schwartz Surgery\n\nGeneral anaesthesia is the preferred choice for open as well as laparoscopic repair.", 'role': 'assistant'}]