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Health See other Health Articles Title: Open Inguinal Hernia Repair Medscape... Inguinal hernia repair is one of the most commonly performed surgical procedures in the world. Most surgeons now prefer to perform a tension-free mesh repair. The Lichtenstein tension-free hernioplasty is currently one of the most popular techniques for repair of inguinal hernias. Indications and contraindications The existence of an inguinal hernia has traditionally been considered sufficient reason for operative intervention. However, the following considerations should be taken into account: Some studies have shown that the presence of a reducible hernia is not, in itself, an indication for surgery and that the risk of incarceration is less than 1% Symptomatic patients should undergo repair Even asymptomatic patients who are medically fit should be offered surgical repair Because of the higher frequency of femoral hernias in women, procedures that provide coverage of the femoral space (eg, laparoscopic repair) at the time of initial operation may be better suited for women as primary repairs Inguinal hernia repair has no absolute contraindications. However, the following considerations should be taken into account: Any medical issues should be fully addressed beforehand and the operation delayed accordingly Patients with elevated American Society of Anesthesiologists (ASA) scores and high operative risk should undergo a full preoperative workup and determination of the risk-to-benefit ratio Recurrences after a primary posterior technique may be treated with Lichtenstein hernioplasty; recurrences after a primary anterior technique should be treated with TEP, TAPP, or open posterior repair Asymptomatic reducible direct inguinal hernia in an elderly patient with multiple uncontrollable comorbidities and an elevated ASA score does not require repair and may be left alone for close observation and follow-up See Overview for more detail. Preparation No special equipment is required for inguinal hernia repair. Instruments and materials on hand may include the following: Syringe 25-Gauge needle Surgical knife with blade Mosquito forceps Dissecting scissors Polypropylene (Prolene) or polyester mesh Langenbeck retractors Adson thumb forceps Needle holder Sutures (absorbable or nonabsorbable) Penrose drain or umbilical tape Inguinal hernia repair can be performed with the following types of anesthesia: General Regional (spinal epidural) Local (infiltration field block) For Lichtenstein hernioplasty, local anesthesia is safe and generally preferable. Antibiotic prophylaxis is not routinely indicated in low-risk cases but may be considered when risk factors are present. See Periprocedural Care for more detail. Procedure Inguinal hernia repairs are of the following 3 general types: Herniotomy (removal of the hernial sac only) Herniorrhaphy (herniotomy plus repair of the posterior wall of the inguinal canal) Hernioplasty (herniotomy plus reinforcement of the posterior wall of the inguinal canal with a synthetic mesh) The Lichtenstein tension-free mesh repair, which is an example of hernioplasty and is currently one of the most popular open inguinal hernia repair techniques, includes the following components: Opening of the subcutaneous fat along the line of the incision Opening of the Scarpa fascia down to the external oblique aponeurosis and visualization of the external inguinal ring and the lower border of the inguinal ligament Opening of the deep fascia of the thigh and exposure of the femoral canal to check for a femoral hernia Division of the external oblique aponeurosis from the external ring laterally for up to 5 cm, safeguarding the ilioinguinal nerve Mobilization of the superior (safeguarding the iliohypogastric nerve) and inferior flaps of the external oblique aponeurosis to expose the underlying structures Mobilization of the spermatic cord, along with the cremaster, including the ilioinguinal nerve, the genitofemoral nerve, and the spermatic vessels; all of these structures may then be encircled in a Penrose drain or tape Opening of the coverings of the spermatic cord and identification and isolation of the hernia sac Inversion, division, resection, or ligation of the sac, as indicated Placement and fixation of mesh to the edges of the defect or weakness in the posterior wall of the inguinal canal to create a new artificial internal ring, with care taken to allow some laxity to compensate for increased intra-abdominal pressure when the patient stands Resection of any nerves that are injured or of doubtful integrity In males, gentle pulling of the testes back down to their normal scrotal position Closure of spermatic cord layers, the external oblique aponeurosis, subcutaneous tissue, and the skin Other approaches to open inguinal hernia repair include the following: Plug-and-patch repair - This adds a polypropylene plug shaped as a cone, which can be deployed into the internal ring after reduction of an indirect sac Prolene Hernia System (PHS) - This consists of an anterior oval polypropylene mesh connected to a posterior circular component McVay repair - In this approach, the conjoined (transversus abdominis and internal oblique) tendon is sutured to the inguinal ligament with interrupted nonabsorbable sutures Bassini repair - This approach involves suturing the transversalis fascia and the conjoined tendon to the inguinal ligament behind the spermatic cord, as well as placing a vertical relaxing incision in the anterior rectus sheath Shouldice repair - This is a four-layer procedure in which transversalis fascia is incised from the internal ring laterally to the pubic tubercle medially, upper and lower flaps are created and then overlapped with two layers of sutures, and the conjoined tendon is sutured to the inguinal ligament (again in two overlapping layers) Darn repair - This is a pure-tissue tensionless technique that is performed by placing a continuous suture between the conjoined tendon and the inguinal ligament without approximating the two structures See Technique for more detail. Image library Open inguinal hernia repair. Indirect hernia sac dOpen inguinal hernia repair. Indirect hernia sac dissected and being separated from lipoma of cord and cord structures. Next Section: Background Read more about Open Inguinal Hernia Repair on Medscape Related Reference Topics Laparoscopic Inguinal Hernia Repair Inguinal Region Anatomy Umbilical Hernia Repair Related News and Articles The INCH-Trial The Case of the Author With an Aching Groin Mass Abdominal Wall Reconstruction With Components Separation and Mesh Reinforcement in Complex Hernia Repair About Medscape Drugs & Diseases Post Comment Private Reply Ignore Thread Top • Page Up • Full Thread • Page Down • Bottom/Latest Begin Trace Mode for Comment # 2.
#2. To: Tatarewicz (#0)
This was done on my groin, right-side, ten days back, and it's not been fun; not awful, but not wonderful.
There are no replies to Comment # 2. End Trace Mode for Comment # 2.
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