Continuing Medical Education

CME Questions

This section provides a review. Mark each statement according to the factual material contained in this issue and the opinions of the authors. A score of 70% is required to qualify for CME credit.

Article One (pp. 123–131)

1. Which of the following is not one of the phases of healing in humans?

   • Inflammatory

   • Migratory

   • Proliferative

   • Remodeling

2. The phases of healing are discrete with no overlap from a cellular or signaling pathway standpoint. True or False?

3. There is clear evidence that the use of corticosteroids results in anastomotic complications in humans. True or False?

4. Which of the following are not benefits of the use of omental wrapping of an intestinal anastomosis?

   • Promotion of collagen degradation

   • Promotion of angiogenesis

   • Peri-anastomotic lymphatic drainage

   • Assists with sealing the serosal suture line

5. All bioprosthetic meshes are not identical and their use must be individualized to each patient and indication for use in abdominal wall surgery. True or False?

   Article Two (pp. 132–137)

6. Effective hernia mesh should

   • be antimicrobial

   • be absorbable

   • have adequate tensile strength

   • be well tolerated by the host

   • C and D

7. The most important factor in host tissue response to implanted biological mesh is

   • Tissue source

   • Tissue processing

   • Blood type of the host

   • Length of time mesh has been implanted

   Article Three (pp. 138–146)

8. A 55 year old male presents for elective laparoscopic ventral hernia repair following a laparoscopic right colon resection 2 years earlier. The mesh is to be placed on the undersurface of the abdominal wall, against the peritoneal surface. The best choice of mesh would be:

   • Polypropylene

   • ePTFE

   • Composite with ePTFE and Polypropylene

   • Human acellular dermal matrix

9. A 25 year old male underwent a damage control laparotomy for a gunshot wound to the abdomen. He has a colostomy and a large ventral hernia. He would like the hernia repaired and the colostomy closed. The best approach to repairing the hernia would be:

   • Composite with ePTFE and Polypropylene in the intraperitoneal location

   • Polypropylene mesh using the sublay (between fascia and peritoneal lining) approach

   • Human acellular dermal matrix mesh with the inlay technique (sewn to edge of fascia)

   • Porcine dermal collagen mesh with fascial closure and sublay technique (between fascia and peritoneal lining)

   Article Four (pp. 147–153)

10. The use of mesh reinforcement for midline wounds is appropriate in all patients. True or False?

11. Hernia formation after ostomy closure occurs in what percentage of patients?

    • 5%

    • 15%

    • 30%

    • 60%

12. Biologic mesh always leads to lower recurrence rates and less infection than synthetic mesh. True or False?

    Article Five (pp. 154–159)

13. Categories of staple line reinforcement include which of the following:

    • Bioabsorbable

    • Permanent

    • Semiabsorbable

    • All of the above

    • None of the above

14. At what point in anastomotic healing does collagen synthesis predominate?

    • Day 3

    • Day 4

    • Day 5

    • Day 6

    • Day 7

15. Which of the following are negatively impacted by anastomotic leak?

    • Overall survival

    • Local Recurrence

    • Rate of anastomotic stricture

    • A and B

    • All of the above

16. Staple line reinforcement with polyglycolic acid is universally known to decrease anastomotic leak rate. True or False?

    Article Six (pp. 160–169)

17. The preferred method of repair of parastomal includes all of the following steps except:

    • Reduction of hernia

    • Excision of hernia sac

    • Repair of defect

    • Re-siting of stoma

    • Reinforcement of stoma site with mesh

18. Which of the following most aptly describes a Sugarbaker repair?

    • Onlay of mesh over repaired parastomal hernia site

    • Re-siting of stoma with retro-rectus placement of biologic mesh

    • Repair of parastomal defect with hernia sac excision and Intraperitoneal ring of mesh placed around stomal limb

    • Repair of parastomal defect with hernia sac excision and Intraperitoneal mesh which lateralizes stoma and secures bowel to abdominal wall

    • Retrorectus ring of mesh placed around initial stoma site

19. Prophylactic placement of mesh at the time ostomy creation signifi cantly decreases the rate of parastomal hernia formation. True or False?

20. Which approach to parastomal hernia repair has been shown to have improved outcomes with the laparoscopic approach?

    • Keyhole repair

    • Sugarbaker repair

    • Resiting with onlay mesh

    • Primary repair with hernia sac excision and trans-fascial repair of defect

    Article Seven (pp. 170–179)

21. The use of fibrin glue is associated with a high risk of incontinence. True or False?

22. The use of fibrin glue is associated with a high risk of incontinence. True or False?

    Article Eight (pp. 180–180)

23. The routine use of transvaginal mesh is recommended by the Food and Drug Adminstration. True or false?

24. Ventral mesh rectopexy includes all of the following except:

    • Preservation of the lateral rectal stalks

    • Posterior mobilization of the rectum

    • Anterior mobilization of the rectum

    • Fixation of mesh to the sacral promontory

25. The preservation of the lateral stalks during operative management of the pelvic organ prolapse is theorized to do which of the following post-operatively:

    • Increase incidence constipation symptoms

    • Decrease recurrence rates

    • Decrease the incidence of constipation symptoms and increase recurrence rates

    • Decrease the incidence of constipation symptoms and recurrence rates