Surg Clin North Am. Dec;78(6) Inguinal hernia repair. The Nyhus posterior preperitoneal operation. Patiño JF(1), García-Herreros LG, Zundel N. A hernia is an outpouching of the parietal peritoneum through a preformed or secondarily established hiatus. If the hernia Table Ib. Nyhus hernia classification. Adapted with permission from Nyhus LM, Klein MS, Rogers FB. Inguinal hernia. Curr Probl Surg ;

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Femoral Hernia Five to seven percent of all hernias are femoral hernias. Init was Lichtenstein who advocated and used mesh to bolster the repair of both direct and recurrent hernias. A clear understanding of the epidemiology and anatomy of inguinal hernias provides a solid foundation for timely diagnosis and care. Metabolic disorders such as obesity, renal insufficiency, diabetes and deficiency of protein, coagulation factor VIII or vitamin C have also an impairment on the wound healing, smoking as well as certain medications, such as steroids and chemotherapeutic agents.

The ilioinguinal nerve traverses the inguinal canal near the external inguinal ring and provides unilateral sensory innervation to the pubic region and the upper portion of the scrotum or the labia majora.

Some concern exists about the long-term safety of implanted prosthetic material, particularly the potential for infection or erosion. The mesh repair was first introduced by Usher who published his results with mesh made from nonresorbable polypropylene in Create a free personal account to download free article PDFs, sign up for alerts, and more.

Management includes a transperitoneal or preperitoneal approach and hernia orifice closure with direct suture or mesh. Average of 10 months range: Sonography may be useful in diagnosing inguinal hernias in patients who report symptoms but do not have a palpable defect. When the potential complications of incarceration and strangulation are weighed against the minimal risks of hernia repair particularly when local anesthesia is usedthe early repair of groin hernias is clearly justified.


Mesh plug hernia repair: More serious complications, such as major hemorrhage, osteitis and testicular atrophy, occur in fewer than 1 percent of patients undergoing herniorrhaphy.

Nyhus and Condon’s Hernia

In some series, the recurrence rate following repair of a recurrent hernia is as high as 30 percent, which is significantly greater than the recurrence rate after initial repairs.

The hernia is present in about one to every five birth, the incidence in black infants being up to eight times higher than in white infants. Patients occasionally respond poorly to a general anesthetic and require overnight hospitalization because of nausea, excessive sedation or urinary retention. If the fascial defect is less then 1. Tension-free repair can be performed using any type of anesthesia.

Consequently, the bowel or vascular structures may be injured during the procedure Figure 8. The presence of incarceration or strangulation usually mandates urgent operative repair. In both the TAPP and TEP approaches, the hernia sac is reduced, and a large piece of mesh is placed to cover the indirect, direct and femoral areas of the inguinal region.

Patients with such injuries present with pain in the groin and thigh. The therapy is always surgical. Complications of groin hernia. Long-term mesh migration with arrosion of neighboring structures e. Recurrence is the most common long-term complication of inguinal herniorrhaphy. A broad portion of mesh is stapled to span both hernia defects. This book is recommended for both the novice and the well-established general surgeon. Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repair.

The outcome of nonabsorbable mesh placed within the abdominal cavity: How important is it? Posterior iliopubic tract repair. Hernia recurrence following inguinal herniorrhaphy is usually caused by the breakdown of a repair performed with tension along the fascial suture lines. Inflation of the balloon creates a working space.

The umbilicus is a natural hernial opening in the abdominal wall.

The develop typically in locations where larger blood vessels or the spermatic cord lie, or where previous incisions were made. Mesh is used to reconstruct the inguinal canal. Hernia repair using prosthetic mesh would be a good choice in the patient with a direct hernia or in the older patient with a longstanding hernia and attenuated fascia. They are acquired, occurring predominantly in females female to male ratio of 6: A randomized controlled trial for inguinal hernia repair to compare the Shouldice and the Bassini-Kirschner operation.


Minimal tension is used to bring tissues together. Staples are not used in proximity to neurovascular structures. Management involves operative therapy by crural, inguinal, or preperitoneal approach for direct fixation of the inguinal ligament to the fascia pectinea of the pubic bone.

Support Center Support Center. The addition of color-coded images of Doppler sonography and clear schematic anatomical representations give this book a superior edge.

Total extraperitoneal laparoscopic repair. Incisional or Recurrent Hernia Any recurrent hernia, either inguinal, epigastric, umbilical, or at any other location, must be understood as an incisional hernia.

Surgical Options in the Management of Groin Hernias – – American Family Physician

Create a free personal account to download free article PDFs, sign up for alerts, customize your interests, and more. Group 1 hernia repairs Bassini, McVay and Shouldice techniques involve byhus the external oblique aponeurosis and freeing the spermatic cord.

A comparative retrospective study of operated incisional hernias] Chirurg. Disregarding the historical precursors of inguinal hernia herrnia by barbers, rupture hernka, and bathing masters, the real history of inguinal hernia surgery begins at the end of the nineteenth century. Average of 3 years, with a range of 1 to 5 years. Route of a femoral hernia. Diagnosis History, local examination with inspection and palpation of the hernial opening, auscultation, and diaphanoscopy are employed for hernia diagnosis.

Either general or regional spinal anesthesia may be used in these patients.

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