This presentation gives general overview of European Hernia Society (EHS) guidelines regarding post operative care and complications in adult inguinal hernia.
The document discusses properties that surgeons should consider when choosing a mesh for hernia repair. Ideal meshes are lightweight, with large pores to reduce foreign body reaction and chronic pain. Monofilament meshes have the lowest risk of infection. For intraperitoneal placement, composite meshes may reduce adhesions by providing an absorbable surface. Overall, lightweight polypropylene or polyester meshes are generally suitable in most contexts by balancing strength, flexibility and biocompatibility.
LAPAROSCOPIC INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparascopicinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy and Open inguinal hernia repair
• In this video today, I have discussed Laparoscopic Inguinal Hernia Repair- both TAPP and TEP approaches.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
An exploratory laparotomy is a surgical procedure where the abdomen is opened to examine the internal organs. It is performed under general anesthesia through an upper midline incision. Indications include trauma, infections, malignancy, complications of other procedures, and removal of foreign bodies. During the procedure, the surgeon examines the abdominal organs and treats any issues found. Potential complications include ileus, infection, hernia, and adhesive obstruction.
A stoma is a surgically created opening that allows stool or urine to exit the body. There are three main types - colostomy, ileostomy, and urostomy. A colostomy diverts feces, while an ileostomy diverts intestinal contents which are usually liquid. A urostomy diverts urine. Complications can include prolapse, retraction, hernia, and skin irritation. When siting a stoma, it is important to choose a well-vascularized area that is away from skin folds, scars, and bony prominences to help prevent these complications.
Wound dehiscence is a complication of surgery where the surgical incision ruptures or reopens. It can lead to evisceration of internal organs. Risk factors include obesity, diabetes, wound infection, and surgical factors like tension on the incision. Symptoms include pain, swelling, and drainage at the wound site. Treatment depends on the severity but may involve antibiotics, packing the wound, or re-suturing the incision. Negative pressure wound therapy can also be used to help close wounds at high risk of dehiscence. Preventing wound dehiscence requires proper surgical technique like layered closure with adequate suture length and tissue bites.
1) Inguinal hernias are common, with approximately 700,000 repairs performed annually in the US, mostly occurring in males.
2) There are two main types of inguinal hernias - indirect and direct. Indirect hernias are congenital while direct hernias are acquired lesions that occur through the posterior inguinal wall.
3) Common surgical repair options include the Lichtenstein tension-free repair using mesh, the Shouldice repair with overlapping tissue layers, and laparoscopic repairs like TAPP and TEP which utilize a mesh placed laparoscopically.
Surgical drains have several purposes and types. They help evacuate fluids from surgical sites to prevent infection and allow wounds to heal. Common types include closed suction drains like Jackson-Pratt drains and open drains like Penrose drains. Placement, securing, and care of drains is important to avoid complications like infection, displacement, or blockage. Drains are removed once drainage decreases significantly or they are no longer needed.
The document discusses surgical meshes and methods of fixation for hernia repair. It covers biologic and synthetic meshes and factors that influence hernia occurrence. Direct closure of hernias has a high recurrence rate of around 50%, which is reduced to around 5-18% when meshes are used. Long stitch lengths during closure are associated with higher rates of surgical site infection and hernia recurrence compared to short stitch lengths. Polypropylene meshes allow for tissue ingrowth but can cause complications like chronic infection, fistulas and erosion over time. Other synthetic mesh options discussed include ePTFE meshes.
The document discusses properties that surgeons should consider when choosing a mesh for hernia repair. Ideal meshes are lightweight, with large pores to reduce foreign body reaction and chronic pain. Monofilament meshes have the lowest risk of infection. For intraperitoneal placement, composite meshes may reduce adhesions by providing an absorbable surface. Overall, lightweight polypropylene or polyester meshes are generally suitable in most contexts by balancing strength, flexibility and biocompatibility.
LAPAROSCOPIC INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparascopicinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy and Open inguinal hernia repair
• In this video today, I have discussed Laparoscopic Inguinal Hernia Repair- both TAPP and TEP approaches.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
An exploratory laparotomy is a surgical procedure where the abdomen is opened to examine the internal organs. It is performed under general anesthesia through an upper midline incision. Indications include trauma, infections, malignancy, complications of other procedures, and removal of foreign bodies. During the procedure, the surgeon examines the abdominal organs and treats any issues found. Potential complications include ileus, infection, hernia, and adhesive obstruction.
A stoma is a surgically created opening that allows stool or urine to exit the body. There are three main types - colostomy, ileostomy, and urostomy. A colostomy diverts feces, while an ileostomy diverts intestinal contents which are usually liquid. A urostomy diverts urine. Complications can include prolapse, retraction, hernia, and skin irritation. When siting a stoma, it is important to choose a well-vascularized area that is away from skin folds, scars, and bony prominences to help prevent these complications.
Wound dehiscence is a complication of surgery where the surgical incision ruptures or reopens. It can lead to evisceration of internal organs. Risk factors include obesity, diabetes, wound infection, and surgical factors like tension on the incision. Symptoms include pain, swelling, and drainage at the wound site. Treatment depends on the severity but may involve antibiotics, packing the wound, or re-suturing the incision. Negative pressure wound therapy can also be used to help close wounds at high risk of dehiscence. Preventing wound dehiscence requires proper surgical technique like layered closure with adequate suture length and tissue bites.
1) Inguinal hernias are common, with approximately 700,000 repairs performed annually in the US, mostly occurring in males.
2) There are two main types of inguinal hernias - indirect and direct. Indirect hernias are congenital while direct hernias are acquired lesions that occur through the posterior inguinal wall.
3) Common surgical repair options include the Lichtenstein tension-free repair using mesh, the Shouldice repair with overlapping tissue layers, and laparoscopic repairs like TAPP and TEP which utilize a mesh placed laparoscopically.
Surgical drains have several purposes and types. They help evacuate fluids from surgical sites to prevent infection and allow wounds to heal. Common types include closed suction drains like Jackson-Pratt drains and open drains like Penrose drains. Placement, securing, and care of drains is important to avoid complications like infection, displacement, or blockage. Drains are removed once drainage decreases significantly or they are no longer needed.
The document discusses surgical meshes and methods of fixation for hernia repair. It covers biologic and synthetic meshes and factors that influence hernia occurrence. Direct closure of hernias has a high recurrence rate of around 50%, which is reduced to around 5-18% when meshes are used. Long stitch lengths during closure are associated with higher rates of surgical site infection and hernia recurrence compared to short stitch lengths. Polypropylene meshes allow for tissue ingrowth but can cause complications like chronic infection, fistulas and erosion over time. Other synthetic mesh options discussed include ePTFE meshes.
This document discusses various types of stomas including colostomies and ileostomies. It describes their indications, techniques for formation, types like end, loop and continent variations, as well as complications and management strategies. Stomas are surgically created openings of the intestinal or urinary tract onto the abdominal wall to divert feces or urine. Proper technique and siting are important to reduce complications.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
This document discusses laparoscopic cholecystectomy (LC), including:
- The history and development of LC since its invention in 1985.
- The standard four-port technique for LC and strategies to minimize bile duct injuries like adopting the Critical View of Safety method.
- Potential complications of LC like hemorrhage, bile leak, and bile duct injury which can occur if the hepatocystic triangle anatomy is not correctly identified.
- Techniques to help identify anatomy like intraoperative cholangiography and using landmarks like Rouviere's sulcus and the epicholedochal plexus.
This document discusses splenectomy, the surgical removal of the spleen. It defines splenectomy and outlines the relevant anatomy of the spleen. The document then discusses the indications for splenectomy, including trauma, hematological disorders, tumors, and vascular abnormalities. It covers the preoperative preparation, anesthesia, positioning, exposure, closure, and postoperative management of splenectomy. Finally, it lists some potential complications of splenectomy.
The spleen is an organ located in the upper left abdomen. It filters blood and fights infections. A splenectomy is the surgical removal of the spleen. It is usually performed laparoscopically to avoid complications of open surgery. During the procedure, the surgeon uses cameras and surgical tools inserted through small incisions to carefully dissect and divide attachments of the spleen. This allows the spleen to be removed while preserving surrounding structures like the pancreas and stomach. A splenectomy may be recommended for conditions like immune thrombocytopenia or certain blood disorders.
This document discusses surgical considerations for rectal cancer, including:
1. The total mesorectal excision (TME) technique aims to remove the mesorectum containing all lymph nodes, leading to low local recurrence rates of 3-4% after 5-10 years.
2. Pre-operative chemoradiotherapy can downstage tumours and improve survival, especially for T3/T4 tumours.
3. A modified TME removing the mesorectum at least 5cm below the tumour is acceptable for high and mid rectal cancers, as distal spread beyond this is rare.
4. Good surgical outcomes depend on meticulous technique, surgeon experience operating in the pelvis, and multidis
Types of intestinal stomas and management Ankita Singh
The document discusses types of intestinal stomas including classifications based on duration, anatomical location, and reconstruction. It covers indications for stoma creation, principles of stoma formation including challenges, common complications, and dietary advice for ostomates. Stoma appliances and management of various stoma-related complications are also described.
Ventral hernias occur when abdominal contents protrude through weaknesses in the abdominal wall. There are several types of ventral hernias including umbilical, epigastric, incisional, and parastomal hernias. Incisional hernias occur through surgical scars and are more common with obesity, advanced age, and emergency surgeries. Treatment depends on hernia size but may involve primary repair for small defects or prosthetic mesh placement for larger defects. Laparoscopic repair is preferred when feasible due to benefits like fewer infections and shorter recovery.
This document provides information on the management of inguinal hernias. It discusses the historical development of hernia repair techniques from the 15th century to modern methods. Investigation methods such as ultrasound, CT, MRI, and herniography are outlined. Surgical techniques for hernia repair including herniotomy, herniorrhaphy, hernioplasty, and laparoscopic repair are described in detail. Post-operative complications of open and laparoscopic hernia repair are also reviewed. The conclusion states that laparoscopic and Lichtenstein open mesh repairs have good long-term results and low recurrence rates compared to other open hernia repair techniques.
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
Resection & anastomosis of boweL its complications PRANAYA PPTPRANAYA PANIGRAHI
This document discusses intestinal resection and anastomosis. It defines anastomosis as establishing communication between two portions of intestine after removal of diseased bowel. Factors that influence healing, techniques for performing anastomoses (hand sewn vs. stapling), and common complications are described. Maintaining adequate blood supply, tension-free closure, and paying attention to technical details are emphasized for achieving successful anastomotic healing.
This document discusses femoral and umbilical hernias. It describes the anatomy of the femoral canal and ring, then covers the causes, clinical features, diagnosis, and treatment approaches for femoral hernias. It notes femoral hernias are more common in females and the right side is more affected. For treatment, it describes the low, inguinal, and high surgical approaches. It also briefly discusses umbilical hernias, noting they are more common in infants and adults with repeated pregnancies or obesity. Treatment involves surgery to repair the defect with sutures or mesh.
This document discusses hemorrhoidectomy, which is the surgical excision of hemorrhoids. It defines hemorrhoidectomy and lists its indications. The types of hemorrhoidectomy procedures are open, closed, and stapled. Preoperative preparation includes a high fiber diet, stool softeners, and antibiotics. The procedure involves excising hemorrhoids using spinal or general anesthesia and leaving tissue bridges between excised areas. Post-operative management includes analgesia, laxatives, and sitz baths. Complications can include bleeding, urinary retention, impaction, stenosis, fissures, tags, recurrence, and incontinence.
- Intestinal stomas are surgically created openings of the small or large intestine onto the abdominal wall. There are three main types: colostomy, ileostomy, and loop stoma.
- Complications include prolapse, herniation, stenosis, dermatitis from effluent, and obstruction. Dietary advice focuses on reducing gas, bulk and odorous foods. Management involves properly attaching collection bags and monitoring for complications.
This document provides information about colostomies, including:
1. A colostomy is a stoma of the colon that diverts fecal matter and flatus by creating an opening between the colon and skin.
2. Indications for colostomy include both congenital conditions like Hirschsprung's disease and acquired conditions like intestinal obstruction, gangrenous bowel, or protecting a bowel anastomosis.
3. Colostomies can be classified temporally as temporary or permanent, anatomically by the portion of colon used, or constructionally as loop or divided depending on if the bowel is divided or intact.
Surgical drains are devices that drain fluids, blood, or air that can accumulate after surgery. There are different types of drains classified as open or closed, and active or passive. Drains are indicated for therapeutic, diagnostic, prophylactic, monitoring, or palliative purposes. Common types include Jackson-Pratt, hemovac, pigtail, and penrose drains. Drains must be properly assessed, maintained if needed, and removed once drainage decreases to prevent complications like infection, blockage, or tissue damage.
This Presentation describes the historical background of ALMOST ALL types of hernia that general surgery resident can face, along with the rationale of why each type of hernia is so named.
This document discusses various types of stomas including colostomies and ileostomies. It describes their indications, techniques for formation, types like end, loop and continent variations, as well as complications and management strategies. Stomas are surgically created openings of the intestinal or urinary tract onto the abdominal wall to divert feces or urine. Proper technique and siting are important to reduce complications.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
This document discusses laparoscopic cholecystectomy (LC), including:
- The history and development of LC since its invention in 1985.
- The standard four-port technique for LC and strategies to minimize bile duct injuries like adopting the Critical View of Safety method.
- Potential complications of LC like hemorrhage, bile leak, and bile duct injury which can occur if the hepatocystic triangle anatomy is not correctly identified.
- Techniques to help identify anatomy like intraoperative cholangiography and using landmarks like Rouviere's sulcus and the epicholedochal plexus.
This document discusses splenectomy, the surgical removal of the spleen. It defines splenectomy and outlines the relevant anatomy of the spleen. The document then discusses the indications for splenectomy, including trauma, hematological disorders, tumors, and vascular abnormalities. It covers the preoperative preparation, anesthesia, positioning, exposure, closure, and postoperative management of splenectomy. Finally, it lists some potential complications of splenectomy.
The spleen is an organ located in the upper left abdomen. It filters blood and fights infections. A splenectomy is the surgical removal of the spleen. It is usually performed laparoscopically to avoid complications of open surgery. During the procedure, the surgeon uses cameras and surgical tools inserted through small incisions to carefully dissect and divide attachments of the spleen. This allows the spleen to be removed while preserving surrounding structures like the pancreas and stomach. A splenectomy may be recommended for conditions like immune thrombocytopenia or certain blood disorders.
This document discusses surgical considerations for rectal cancer, including:
1. The total mesorectal excision (TME) technique aims to remove the mesorectum containing all lymph nodes, leading to low local recurrence rates of 3-4% after 5-10 years.
2. Pre-operative chemoradiotherapy can downstage tumours and improve survival, especially for T3/T4 tumours.
3. A modified TME removing the mesorectum at least 5cm below the tumour is acceptable for high and mid rectal cancers, as distal spread beyond this is rare.
4. Good surgical outcomes depend on meticulous technique, surgeon experience operating in the pelvis, and multidis
Types of intestinal stomas and management Ankita Singh
The document discusses types of intestinal stomas including classifications based on duration, anatomical location, and reconstruction. It covers indications for stoma creation, principles of stoma formation including challenges, common complications, and dietary advice for ostomates. Stoma appliances and management of various stoma-related complications are also described.
Ventral hernias occur when abdominal contents protrude through weaknesses in the abdominal wall. There are several types of ventral hernias including umbilical, epigastric, incisional, and parastomal hernias. Incisional hernias occur through surgical scars and are more common with obesity, advanced age, and emergency surgeries. Treatment depends on hernia size but may involve primary repair for small defects or prosthetic mesh placement for larger defects. Laparoscopic repair is preferred when feasible due to benefits like fewer infections and shorter recovery.
This document provides information on the management of inguinal hernias. It discusses the historical development of hernia repair techniques from the 15th century to modern methods. Investigation methods such as ultrasound, CT, MRI, and herniography are outlined. Surgical techniques for hernia repair including herniotomy, herniorrhaphy, hernioplasty, and laparoscopic repair are described in detail. Post-operative complications of open and laparoscopic hernia repair are also reviewed. The conclusion states that laparoscopic and Lichtenstein open mesh repairs have good long-term results and low recurrence rates compared to other open hernia repair techniques.
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
Resection & anastomosis of boweL its complications PRANAYA PPTPRANAYA PANIGRAHI
This document discusses intestinal resection and anastomosis. It defines anastomosis as establishing communication between two portions of intestine after removal of diseased bowel. Factors that influence healing, techniques for performing anastomoses (hand sewn vs. stapling), and common complications are described. Maintaining adequate blood supply, tension-free closure, and paying attention to technical details are emphasized for achieving successful anastomotic healing.
This document discusses femoral and umbilical hernias. It describes the anatomy of the femoral canal and ring, then covers the causes, clinical features, diagnosis, and treatment approaches for femoral hernias. It notes femoral hernias are more common in females and the right side is more affected. For treatment, it describes the low, inguinal, and high surgical approaches. It also briefly discusses umbilical hernias, noting they are more common in infants and adults with repeated pregnancies or obesity. Treatment involves surgery to repair the defect with sutures or mesh.
This document discusses hemorrhoidectomy, which is the surgical excision of hemorrhoids. It defines hemorrhoidectomy and lists its indications. The types of hemorrhoidectomy procedures are open, closed, and stapled. Preoperative preparation includes a high fiber diet, stool softeners, and antibiotics. The procedure involves excising hemorrhoids using spinal or general anesthesia and leaving tissue bridges between excised areas. Post-operative management includes analgesia, laxatives, and sitz baths. Complications can include bleeding, urinary retention, impaction, stenosis, fissures, tags, recurrence, and incontinence.
- Intestinal stomas are surgically created openings of the small or large intestine onto the abdominal wall. There are three main types: colostomy, ileostomy, and loop stoma.
- Complications include prolapse, herniation, stenosis, dermatitis from effluent, and obstruction. Dietary advice focuses on reducing gas, bulk and odorous foods. Management involves properly attaching collection bags and monitoring for complications.
This document provides information about colostomies, including:
1. A colostomy is a stoma of the colon that diverts fecal matter and flatus by creating an opening between the colon and skin.
2. Indications for colostomy include both congenital conditions like Hirschsprung's disease and acquired conditions like intestinal obstruction, gangrenous bowel, or protecting a bowel anastomosis.
3. Colostomies can be classified temporally as temporary or permanent, anatomically by the portion of colon used, or constructionally as loop or divided depending on if the bowel is divided or intact.
Surgical drains are devices that drain fluids, blood, or air that can accumulate after surgery. There are different types of drains classified as open or closed, and active or passive. Drains are indicated for therapeutic, diagnostic, prophylactic, monitoring, or palliative purposes. Common types include Jackson-Pratt, hemovac, pigtail, and penrose drains. Drains must be properly assessed, maintained if needed, and removed once drainage decreases to prevent complications like infection, blockage, or tissue damage.
This Presentation describes the historical background of ALMOST ALL types of hernia that general surgery resident can face, along with the rationale of why each type of hernia is so named.
European Hernia Society (EHS) 2014 guidelines : Closure of abdominal wall inc...Jibran Mohsin
This presentation includes the latest(2014) European Hernia Society (EHS) guidelines regarding the optimal technique and suture material for the closure of elective mid-line abdominal incisions in order to decrease the frequencies of complications especially incisional hernia, wound dehiscence and burst abdomen.
TG13: Updated Tokyo guidelines for acute cholecystitis Jibran Mohsin
The document provides updated guidelines for the diagnosis and management of acute cholecystitis from the Tokyo Guidelines 2013. It details the terminology, etiology, epidemiology, diagnostic criteria including signs, symptoms, imaging and laboratory findings. It establishes criteria for grading the severity of acute cholecystitis cases. The management section outlines antimicrobial therapy, options for gallbladder drainage, and surgical management. Key points include utilizing ultrasonography for initial diagnosis assessment and defining diagnostic criteria as localized signs of inflammation plus systemic signs of inflammation along with imaging characteristics of acute cholecystitis.
This document provides information on direct and indirect inguinal hernias, including their anatomy and symptoms. It also describes the laparoscopic procedure for treating inguinal hernias, including positioning the patient, dissecting the hernia sac, placing mesh to cover the defect, and post-operative care. The laparoscopic approach has advantages over open surgery such as smaller incisions, less tissue disruption, and less post-operative pain, though it requires practice to learn.
Inguinal Hernia is the commonest problem in General surgery. All medical students should know everything about this common problem. In this ppt presentation I have covered all the details regarding Inguinal hernia thoroughly.
Surgical Options In The Management Of Hernia Repairsafarmas
This document outlines surgical options for inguinal hernias. It discusses the definition and types of hernias, including inguinal and femoral hernias. For surgical management, it describes open hernia repair techniques like Bassini, Shouldice, and tension-free repairs using mesh, as well as laparoscopic approaches like TAPP and TEP. Complications are also outlined. The goal of hernia surgery is to reduce hernia contents and repair the defect using herniorrhaphy or hernioplasty techniques to minimize recurrence.
The post operative period begins after surgery and focuses on enabling successful recovery. It aims to reduce mortality, length of stay, and costs through quality care. Patients are monitored in the PACU or SICU by nurses. They assess vitals, consciousness, bleeding, pain/anxiety and more to detect complications and ensure stability for discharge. The goal is safe transfer from intensive recovery phases to continued recovery in step-down units or at home with instructions.
This Presentation focuses on answering the questions the surgical residents face while treating the patients of Deep Venous Thrombosis on surgical floor as per latest (2012) American College of Chest Physician Guidelines
Closure of elective midline abdominal incision: European Hernia Society 2014 ...Jibran Mohsin
1) The document provides guidelines for closing abdominal incisions to decrease the risk of incisional hernias and burst abdomen.
2) It recommends using a non-midline incision whenever possible, as well as continuous suturing with a slowly absorbable monofilament suture in a single layer for midline incisions.
3) The optimal technique remains unclear due to lack of high-quality evidence, but guidelines aim to optimize closure methods based on current best evidence.
Post operative pain management has no specific criteria. Lots of methods and procedures are suggested with various types of drugs. It is just a guideline for management of pain after surgery.
The document discusses ventral hernias, including:
- Incidence and risk factors for ventral hernias
- Options for mesh placement during hernia repair surgery
- Types of prosthetic meshes used, including benefits and disadvantages of polypropylene, ePTFE, polyester, and absorbable barrier-coated meshes
- Studies comparing surgical outcomes and complications between different mesh types
1. The document discusses various markers that can be used to define and assess low cardiac output, including lactate levels, mixed venous oxygen saturation, oxygen delivery and extraction ratio.
2. Treatment for low cardiac output syndrome focuses on improving contractility through the use of inotropic agents like calcium, dobutamine and milrinone, as well as vasodilators to reduce afterload like sodium nitroprusside.
3. The effects of various inotropes are discussed, noting that dopamine has limited benefit and epinephrine does not increase pulmonary or systemic vascular resistance like dopamine. Milrinone provides inotropic and vasodilatory effects with minimal increase in heart rate.
This document discusses various post-operative complications organized into categories. It describes wound complications including seroma, hematoma, wound dehiscence, and surgical site infections. It also covers thermal regulation issues like hypothermia and malignant hyperthermia. Gastrointestinal complications involving ileus, bleeding, and leaks are outlined. Other complications discussed include DVT, pulmonary embolism, infections and fever, pulmonary issues, renal failure, cardiovascular events, neurological problems like stroke and delirium, and diabetic ketoacidosis. Prevention and management strategies are provided for each complication.
Biliary atresia is a condition where the bile ducts outside the liver are blocked. It is the most common cause of jaundice in newborns that requires surgery. The surgery, called a Kasai procedure, involves removing any remaining blocked bile ducts and connecting the liver directly to the intestine to drain bile. Even with surgery, about half of children will develop progressive liver damage requiring transplantation. Early diagnosis before 3 months of age and surgery improve the chances of successful bile drainage and liver function.
The document discusses the anatomy and types of inguinal hernias. It describes the superficial and deep inguinal rings, differences in infants and adults, and contents that pass through the inguinal canal in males and females. It details characteristics of indirect, direct, sliding, and femoral hernias. Risk factors, signs, and surgical treatment are outlined. Strangulated hernias are also summarized, including contents, risk factors, and management approach.
Post-operative care involves monitoring the patient's ABCDEs and vital signs. Oxygen therapy is usually provided until the anaesthetic dissipates. Specific considerations depend on the surgery and may involve drain monitoring, stoma care, or extensive physiotherapy. Pain assessment and management is fundamental, using tools like scales and working with a multi-disciplinary team using medication, positioning, and early mobilization. Mobility should begin within 24 hours to prevent complications while monitoring the patient's condition and risks.
This is a case study done by me as a part of my in-service education progamme in my institution...hope this may help all nurses who wants to do a case study.
Laparoscopic vs Open Inguinal Hernia repairAndrew Wright
This document discusses different types of hernia repair techniques including open and laparoscopic approaches. It provides details on various open tissue repair techniques as well as open mesh repairs like Lichtenstein repair. Laparoscopic repairs like TEP and TAPP are discussed along with their advantages of less pain and faster recovery compared to open repairs. However, laparoscopic repairs are noted to be more technically challenging. Several studies comparing open and laparoscopic outcomes are summarized, finding laparoscopic repairs result in less short-term pain and faster recovery but higher recurrence rates, especially among low-volume surgeons. The document emphasizes the importance of not reserving laparoscopic repairs only for more complex cases in order to overcome the learning curve.
Laparoscopic surgery is the mainstay of surgical management for gynaecological procedures but can be associated with complications in 0.2-10.3% of cases. Common complications include injuries to the gastrointestinal tract and urinary tract. Urinary tract injuries like bladder trauma can occur in 0.02-8.3% of advanced laparoscopy cases from mechanical or electro-thermal trauma. Risk factors include previous pelvic surgery or endometriosis. Ureteric injuries have a reported incidence of 0.06-21% and most commonly occur near the pelvic brim or lateral to the cervix. Gastrointestinal tract injuries have an incidence of 0.13% and most injuries are to the
Urological trauma during O/G proceduresGAURAV NAHAR
Urological injuries, especially to the urinary bladder and ureters, can occur as complications during obstetric and gynecological procedures due to the anatomical proximity of the genital tract. Bladder injuries are most common but ureteral injuries are often not immediately recognized and can lead to long-term complications if not repaired. Various surgical techniques exist for repairing different types and locations of ureteral and bladder injuries. Prevention relies on identifying risk factors, visualizing the ureters, and high clinical suspicion of injury. Early diagnosis and management involving urological consultation are important to avoid long-term complications.
The liver is frequently injured in abdominal trauma due to its location and size. Most liver injuries can be managed non-operatively through observation, though some require procedures to control bleeding. The severity of injury is graded on a scale of I to VI. For blunt trauma patients who are hemodynamically stable without ongoing bleeding, non-operative management is preferred with monitoring and CT scans. Surgical management is used for unstable patients or those with significant bleeding, and focuses on controlling bleeding through sutures, packing, or clamping blood vessels.
Laparoscopy can be used to both diagnose and treat abdominal trauma. It is most effective for hemodynamically stable patients with penetrating injuries or blunt trauma with unclear internal injuries. Key benefits are lower morbidity rates compared to open surgery and ability to identify injuries often missed on imaging like diaphragmatic tears or mesenteric lacerations. The procedure allows for therapeutic repair of injuries to organs like liver, stomach or bowel when laparoscopic expertise is available. Contraindications include hemodynamic instability, clear need for open surgery, or limited laparoscopic resources.
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An inguinal hernia occurs when abdominal contents bulge through the abdominal wall. Surgery is the only effective treatment and involves reinforcing the inguinal canal floor with mesh to provide tension-free repair. Potential complications include chronic groin pain, testicular issues, bleeding, infection, and hernia recurrence which ranges from 0.5-15% depending on repair type and follow up duration. Patient risk factors like smoking, age, and medical conditions can also increase recurrence risk. Most patients recover fully within 4-6 weeks after open surgery or 2-3 weeks after laparoscopic repair.
Renal trauma can occur from blunt or penetrating injuries. Evaluation involves stabilizing the patient, assessing for life-threatening injuries using ATLS protocols, and obtaining imaging. CT is the preferred imaging method and allows grading of injuries according to the AAST scale. Most grade I-III injuries can be managed conservatively with observation. Higher grade injuries may require angioembolization or surgery to control bleeding. Goals of management are to control hemorrhage and salvage renal tissue when possible. Patients require follow-up imaging and monitoring for early or delayed complications.
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This document discusses the management of various abdominal traumas including colorectal, pancreatic, duodenal, and vascular injuries. It provides details on:
- The diagnosis and treatment of colorectal injuries from penetrating or blunt trauma, including factors that influence management decisions like injury grade and presence of contamination.
- Features of pancreatic trauma on imaging like CT and specific signs of ductal injury. Surgical management varies by injury grade but may include drainage, resection, or damage control approaches.
- Common sites and challenges of duodenal injury management related to risk of failure and associated injuries. Treatment depends on injury grade and may involve primary repair, reconstruction, or diversion.
- General principles of abdominal trauma
Management of ureteric injuries requires prompt diagnosis and repair to minimize complications. Ureteric injuries are most commonly caused by iatrogenic factors during surgeries near the ureters like hysterectomy. Diagnosis involves imaging like CT scans to detect contrast extravasation or hydronephrosis. Treatment depends on hemodynamic stability, with stable patients undergoing immediate primary repair and unstable patients getting temporary drainage first. Special circumstances like delayed diagnosis, endoscopic injuries, or fistulas may require additional measures like stenting. Surgical repairs aim to bridge defects with tension-free, spatulated anastomoses and stents to promote healing. Follow-up involves imaging and renal function tests to ensure patency.
This document discusses ureteric injury as a complication of gynecologic surgery. It covers the incidence, risk factors, applied anatomy of the pelvic ureter, common sites of injury, prevention strategies, and management approaches. Ureteric injury can occur in 0.03-6% of hysterectomies, with laparoscopic hysterectomy having the highest risk. The pelvic ureter has variable anatomy and is susceptible to injury at sites like the pelvic brim. Prevention focuses on proper identification and dissection of the ureter during surgery. Management depends on the severity and timing of injury but may involve stenting, urinary diversion, or ureteral reimplantation
Urinary tract injury during female pelvic surgery occurs in 0.3-1% of procedures but can be as high as 2.4%. Risk factors include prior pelvic surgery, endometriosis, and pelvic masses. The ureters pass through the pelvis and can be injured at various points, most commonly when ligating the ovarian or uterine vessels. Identifying and isolating the ureters and bladder during surgery is important to prevent injury from other surgical maneuvers.
Laparoscopy surgery, while minimally invasive, carries risks of complications. Common complications include bowel injury, bleeding, and hernia formation. Bowel injuries can occur from trocars, instruments, or electrocautery and may be difficult to detect, sometimes not appearing for days. Vessel injuries to major blood vessels in the abdomen are also risks. Preventive measures include proper patient positioning, careful trocar placement, and avoiding deep dissection. Neurologic injuries from positioning are rare but possible. The urinary tract is also at risk of injury from instruments. As laparoscopy is used for more complex cases, complication rates can be expected to rise but proper training and awareness of risks can help minimize complications.
This document discusses open and laparoscopic repair of incisional and ventral hernias. It provides information on risk factors, diagnosis, and various surgical techniques for hernia repair including open suture repair, open mesh repair techniques (onlay, inlay, retrorectus/Stoppa repair), and laparoscopic mesh repair. Complications of hernia repair such as seroma, infection, and chronic pain are also reviewed. The document emphasizes that mesh repair has been shown to have lower recurrence rates than suture repair alone and reviews tips for proper laparoscopic mesh handling and fixation to minimize complications.
This document discusses ureteric injuries that can occur during gynecological surgeries. It notes that the most common site of injury is near the pelvic brim at the infundibulopelvic ligament. The most common type of injury is obstruction and the most common cause is attempts to obtain hemostasis. It provides details on the anatomy of the ureter and risk factors for injury. Preventive strategies discussed include preoperative imaging, adequate exposure during surgery, and avoiding blind clamping of vessels near the ureter. Treatment depends on the severity, location, and timing of diagnosis of the injury. Options include conservative management, delayed repair, or immediate reoperation.
1. Colorectal trauma can result from penetrating injuries like gunshots, impalement, or medical procedures. Blunt trauma is rare but can occur from pelvic fractures in car accidents or falls.
2. Treatment depends on factors like injury size, contamination, and time since injury. Small, clean injuries found early may be closed primarily. Larger or delayed injuries usually require resection and colostomy.
3. Rectal injuries require examination to locate them, irrigation, and sometimes drainage or abdominal repair with proximal fecal diversion. Perineal injuries usually cannot be primarily repaired and require diversion.
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A lecture about the management approaches for abdominal vascular injuries. Injury to the major arteries and veins in the abdomen are technical challenge to the surgeon and are often fatal. All vessels are susceptible to injury with penetrating trauma. Vascular injuries in blunt trauma are far less common and usually involve the renal arteries and veins, though all other vessels, including the aorta, can be injured. Blunt trauma results from deceleration, AP compression or pelvic fractures.
This document discusses ureteric injuries that can occur during obstetric and gynecological surgeries and procedures for urinary diversions. It covers the anatomy of the ureters, risk factors for injury, types of injuries, prevention strategies, management approaches, and specific procedures like ileal conduits and continent urinary diversions. Nursing considerations are also outlined for preoperative teaching, postoperative care and monitoring, and potential complications from various urinary diversion surgeries.
1. Bladder injuries can result from blunt trauma, penetrating trauma, or iatrogenic causes, and are more likely if the bladder is full. Management ranges from conservative treatment to surgical repair depending on the severity of injury.
2. Evaluation of suspected bladder trauma involves cystography, cystoscopy, and ultrasound to identify leaks or extravasation. Surgical repair is usually needed for penetrating injuries or injuries inside the abdominal cavity.
3. Conservative management involves catheter drainage, antibiotics, and monitoring for healing without repair. Surgical repair is done by closing mucosa and muscle layers. Complications can include infection, leaks, or fistulas if not properly treated.
Similar to European hernia society guidelines: Adult Inguinal Hernia (Post operative care and complications) (20)
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Dr. Raza Hassan has received poor feedback and attendance from students in his lectures. He believes he is doing a good job by preparing thoroughly from textbooks and lecturing as he was taught. However, the literature identifies issues with his approach, including lack of engagement, outdated content, poor presentation skills, and resistance to change. Effective lectures require interactive methods, multiple sources, visual aids, and addressing different learning styles in a conducive environment.
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Dr. Marina implemented various constructivist teaching methods like peer tutoring, cooperative learning groups, and jigsaw approach in her pharmacology class. However, she faced issues with student and parent complaints. The key issues were ineffective use of peer tutoring due to lack of training, inappropriate grouping of students based only on attributes instead of abilities, and lack of team building skills. The recommendations include using cross-age tutoring instead of same-age, involving parents to explain benefits of peer learning, starting with simple cooperative tasks to build team skills, and considering student abilities for grouping.
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European hernia society guidelines: Adult Inguinal Hernia (Post operative care and complications)
1. European Hernia Society (EHS) guidelines:
Adult Inguinal Hernia
Post-operative care and complications
Jibran Mohsin
Resident, Surgical Unit I
SIMS/Services Hospital, Lahore
4. Postoperative recovery
• defined as a return to normal activities of daily living and the
resumption of paid work.
• Endoscopic inguinal hernia techniques (7 days earlier) > Lichtenstein
technique (4 days earlier) > Conventional tissue repair
5. Postoperative recovery
• Traditionally , recommended postoperative recovery time was 6
weeks (tissue repair under tension)
• NOW, patients should be informed that they can immediately return
to all of their usual activities of daily life if pain permits
6. Aftercare
• Is a lifting, sports or work ban indicated following inguinal hernia
surgery?
7. Aftercare
• The imposition of a temporary ban on lifting, participating in sports or
working after inguinal hernia surgery, is not necessary.
• Probably a limitation on heavy weight lifting for 2–3 weeks is enough.
‘‘Do what you feel you can do.’’
8. Aftercare
• >75% cases can do their own
shopping without assistance
within 6 days after Lichtenstein
technique under local
anaesthesia.
9. Aftercare
Driving after an inguinal hernia operation
• On 7th Post operative day
• 82% after endoscopic repair,
• 64% after Lichtenstein operation and
• 33% of cases after Bassini technique
• According to Lichtenstein clinic
• driving can be resumed straight away.
• It is hardly surprising that every surgeon gives a different recommendation.
11. Postoperative pain control
• Local infiltration of the wound after hernia repair provides extra pain
control and limits the use of analgesics.
12. Complications
• How frequent are complications after inguinal hernia operations, and
can the risk of complications be reduced?
13. Complications
• The overall risk of complications after inguinal hernia operations
reported vary from 15 to 28% in systematic reviews.
• With active monitoring, rates as high as 17 to 50% has been reported.
14. Complications
• Early complications
• hematomas and seromas (8–22%),
• urinary retention and
• early pain
• Late complications
• Persistent pain and
• recurrences
15. Complications
• Hernia surgery is reconstructive surgery and it appears that
meticulous technique pays off, e.g. regarding nerve damage and
recurrences, irrespective of what method of repair has been used
16. Complications
• Which are the specific complications following inguinal hernia
operation and how should they be treated?
17. Hematoma
• Serious, transfusion-requiring hemorrhages rarely occur in the case of
open and endoscopic inguinal hernia surgery.
• The incidence of inguinal hematomas is lower for the endoscopic
techniques (4.2 - 13.1%) than with open repair (5.6 - 16%).
18. Hematoma
• A small hematoma can be treated conservatively.
• For larger hematomas, which also give rise to a lot of pain and/or
tension on the skin, an evacuation of the hematoma under anesthetic
should be considered.
• It is recommended that wound drains are only used where indicated
(much blood loss, coagulopathies).
19. Seroma
• The risk of seroma formation varies between 0.5 and 12.2%.
• significantly higher for the endoscopic techniques than for open
repairs
• Most seromas disappear spontaneously within a period of 6–8 weeks.
20. Seroma
• It is recommended that seromas are not aspirated (except persistent
> 6-8 weeks with risk of infection).
• The risk of seroma is rarely big enough to necessitate leaving a drain,
except in the case of excessive diffuse blood loss or patients with
(iatrogenic) coagulopathies.
21. Wound infection
• The risk of a wound infection following an inguinal hernia operation
with or without mesh should be below 5%.
• The use of mesh in inguinal hernia repair is not associated with a
higher risk of wound infection.
• Superficial infections are rare after endoscopic techniques.
• 1–3% for open versus < 1 % after endoscopic surgery
22. Wound infection
• Deep infections are rare and do not have to lead to the removal of the
mesh when monofilament materials are used
• Drainage and antibiotics are usually sufficient.
• However, removal of the mesh has been described; this is virtually
inevitable in the presence of a multifilament mesh.
23. Results of the systematic review
Open mesh versus open non-mesh Open versus endoscopic
Hematoma 5.5 % versus 6.5 % 10.5 versus 8.6 %
Seroma 2.4 % versus 1.6 % 3.7 % versus 5.7 %
Wound infection 3.4% versus 2.8% 3.1 % versus 1.5 %
24. Urinary retention
• Incidence of urinary retention
• local anaesthesia _ 0.37%
• regional anaesthesia _ 2.42%
• general anaesthesia _ 3.00%
• Endoscopic versus open
• no significant differences in postoperative urinary retention were found
• TEP does not cause outflow obstruction or alteration of the bladder contractility
• The volume of intravenous postoperative fluid administered is a significant risk
factor
25. Bladder damage
• Can occur after both endoscopic and open surgery.
• Uncommon complication that is somewhat more frequent in TAPP.
• Varies from 4.2% in smaller series to 0.2% - 0.1% -0.06%
• Predisposing factors
• full bladder,
• exposure of the retropubic space (particularly after prostate interventions,irradiation
or TAPP) and
• opening of the transversalis fascia/peritoneum in direct hernias.
26. Recommendations
• It is recommended that the patient empties his/her bladder prior to
endoscopic and open operations.
• It is recommended that the fascia transversalis/peritoneum is opened
with restrictivity in open surgery of direct hernias. Take care that the
bladder might be herniated.
27. Ischaemic orchitis, testicular atrophy and
damage to the ductus deferens
• Testicular complications occur after both open and endoscopic hernia
surgery (0.7 %)
• No significant difference in incidence between open and endoscopic
techniques
28. Ischaemic orchitis, testicular atrophy and
damage to the ductus deferens
• Postoperative ischaemic orchitis usually develops within 24–72 h
• may result in testicular necrosis within days or
• have a slower course, resulting in testicular atrophy over a period of several
months.
29. Ischaemic orchitis, testicular atrophy and
damage to the ductus deferens
• Risk factors
• Damage to cremasteric vessels
• recurrent open hernia surgery
• dissection below the level of the pubic tubercle, e.g. after complete excision of
scrotal hernias
• Extensive dissection of the pampiniform plexus
• Tight closure of the internal ring
30. Recommendations
• Minimising cord dissection is recommended (damage to the
spermatic cord structures should be avoided).
• Transection of the hernia sac leaving the distal part in situ is
recommended to reduce the risk of ischaemic orchitis.
(Thrombosis of testicular veins following extensive dissection is considered to
be the cause of ischaemic orchitis)
31. Damage to the intestines
• Damage to the intestines rarely occurs in open hernia surgery and is,
in general related, to an intervention for incarcerated hernia.
• In endoscopic hernia surgery, the risk is low; however, it occurs more
frequently, from 0.0 to 0.21%
• Risk factors
• previous major lower (open) abdominal interventions,
• previous radiotherapy of pelvic organs and
• insufficient insulation of endoscopic instruments during coagulation.
32. Recommendation
• It is recommended that patients with previous major lower (open)
abdominal intervention or previous radiotherapy of pelvic organs do
not undergo endoscopic inguinal hernia surgery.
33. Bowel obstruction
• Incidence after TAPP
• varies from 0.07 to 0.4%
• It may also develop after TEP operation; however, this occurs less
frequently
• Bowel obstruction can develop due to adhesions between the mesh and
the intestines e.g. by inadequate closure of a peritoneal lesion.
• Rare cases of bowel obstruction in port-site hernias have also been
described, especially after TAPP.
34. Recommendation
• It is recommended that, due to the risk of intestinal adhesion and the
risk of bowel obstruction, the extraperitoneal approach (TEP) is used
for endoscopic inguinal hernia operations.
• It is recommended that trocar openings of 10 mm or larger are
closed.
35. Vessel damage
• Damage to the large vessels rarely occur in the case of an open
inguinal hernia operation, and is mostly described in the McVay
technique
• Damage to the epigastric vessels may occur more frequently
• significance of which, however, is obscure,
• since dividing the epigastric vessels is part of the original method in open
preperitoneal techniques such as the Stoppa operation and its unilateral
variety
36. Vessel damage
• In TAPP, blind introduction of the Veress needle and trocars may damage
the aorta, vena cava and iliac vessels.
• The incidence is low and only occasional cases are reported in the hernia
literature.
• In a large series, an incidence of 0.06–0.13% is reported.
• Damage to the inferior epigastric vessels as a consequence of trocar
introduction has an incidence of 0–0.07%.
37. Vessel damage
• It is recommended that the first trocar at endoscopic hernia surgery
(TAPP) is introduced by the open technique.
38. Mesh Migration
• Mesh migration is described after all varieties of mesh repairs but for
plug techniques in particular.
• Migration to the
• intestines,
• urinary bladder,
• femoral vein,
• preperitoneal space and
• scrotum
have been reported
39. Mesh Rejection
• Mesh rejection following different surgical techniques and mesh
materials have also been reported.
40. Specific endoscopic complications
SPECIFIC ENDOSCOPIC COMPLICATIONS
Pneumatic complications • Pneumomediastinum,
• Pneumothorax
• subcutaneous
emphysema
(pneumoscrotum)
• mostly related to a high insufflation
pressure.
• Subcutaneous CO2 emphysema can
occur due to the incorrect placing of the
Veress needle or
• leakage of CO2 along the trocars
Carbon dioxide insufflation-related
complications
• hypercapnia,
• Acidosis
• hemodynamic changes
Hypercapnia was reported in 2/686
patients
Trocar complications Trocar hernias 0.06 to 0.4% for the TAPP to 0.7% for various
endoscopic interventions
41. Chronic pain, nerve damage and neuralgia
• What causes chronic pain after inguinal hernia surgery, can it be
prevented and how can it be treated?
42. Chronic pain, nerve damage and neuralgia
• According to International Association for the Study of Pain (IASP)
• chronic pain is defined as pain lasting for 3 months or more
43. Chronic pain, nerve damage and neuralgia
CAUSES AND RISK FACTORS
The risk of chronic pain after hernia repair with mesh is less than after non-mesh repair.
The risk of chronic pain after endoscopic hernia repair is lower than after open hernia repair. (less nerve damage)
The overall incidence of moderate to severe chronic pain after hernia surgery is around 10– 12%.
(frequency of chronic pain after hernia repair ranged from 0 to 53%.)
The risk of chronic pain after hernia surgery decreases with age.
44. Chronic pain, nerve damage and neuralgia
CAUSES AND RISK FACTORS
Preoperative pain may increase the risk of developing chronic pain after hernia surgery.
(Preoperative chronic pain conditions headache, back pain and IBS correlate with the development of chronic
pain after hernia surgery).
Severe early postoperative pain after hernia surgery is correlated to the development of chronic pain.
Females have an increased risk of developing chronic pain after hernia surgery.
Patients undergoing reoperative surgery for recurrent hernia were at risk of developing chronic neuralgia with
a four-fold higher rate of moderate or severe chronic pain
45. Chronic pain, nerve damage and neuralgia
PREVENTION OF CHRONIC PAIN
Lightweight/Material-reduced/large pore (>1000 μm) meshes in open repair have some advantages with
respect to long-term discomfort and foreign-body sensation in open hernia repair (when only considering
chronic pain).
Prophylactic resection of the ilioinguinal nerve does not reduce the risk of chronic pain after hernia surgery.
Identification of all inguinal nerves during open hernia surgery may reduce the risk of nerve damage and
postoperative chronic groin pain.
46. Chronic pain, nerve damage and neuralgia
TREATMENT OF CHRONIC PAIN
A multidisciplinary approach at a pain clinic is an option for the treatment of chronic postherniorrhaphy pain.
Surgical treatment of specific causes of chronic post-herniorrhaphy pain can be beneficial for the patient, such
as the
• resection of entrapped nerves,
• mesh removal in mesh-related pain,
• removal of endoscopic staples or fixating sutures.
47. Sexual Complaints
• Ejaculatory pain and sexual dysfunction related to inguinal hernia are
evaluated in only a few studies, and prophylactic measures or
treatments have, till now, not been suggested
48. Sexual Complaints
• According to Zieren J et al (2003)
• Preoperative hernia-related sexual dysfunction in 11 patients (15% of a study
group of 73) was successfully treated by the hernia operation in all cases
• In same study group, postoperative sexual dysfunction appeared in ten
patients and recovered spontaneously in six within 12 months.
49. Sexual Complaints
• Danish nationwide questionnaire study of pain related sexual
dysfunction (2004)
• Genital or ejaculatory pain was found in 12.3% and
• 2.8% reported a moderate to severe impairment of sexual activity
• pain was specifically located at the external inguinal ring
• pain was of somatic origin
• related to deterioration in the overall quality of life and sexual function of the
patients.
50. Mortality
Swedish Danish
elective inguinal hernia repair (<1 %) not raised above that of the
background population
• 0.02% under the age of 60 years
• 0.48% above 60 years of age
emergency operation • increased seven-fold after
emergency operations and
• 20- fold if bowel resection was
undertaken
7%
Women have a higher mortality risk than men due to a greater risk for emergency procedure irrespective of
hernia anatomy and a greater proportion of femoral hernia.
After femoral hernia operation, the mortality risk was increased seven-fold for both men and women
51. Recommendations
• It is recommended to offer patients with femoral hernia early planned
surgery, even if symptoms are vague or absent.
• It is recommended to intensify efforts to improve the early diagnosis
and treatment of patients with incarcerated and/or strangulated
hernia.