Inguinal hernia surgery
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This document provides information about inguinal hernia surgery. It describes different types of hernia repair surgeries including hernioplasty, herniorraphy, and herniotomy. It also discusses the indications for surgery, surgical preparation, techniques for different procedures like herniotomy and herniorraphy, types of hernia repairs including Bassini's repair, Shouldice repair, and Lichtenstein tension free mesh repair. Post-operative care and potential complications are also summarized.
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Inguinal hernia surgery
- 17. Hernia repair • Hernioplasty when herniotomy is combined with a reinforced repair of the posterior inguinal canal with autogenous ;patieŶt͛s oǁ Ŷ tissueͿ or heterogenous material such as prolene mesh. • Herniorraphy is somewhat like hernioplasty only that no autogenous or heterogenous material is used for reinforcement. • Herniotomy is a surgical operation where the hernia sac is removed without any repair of the inguinal canal.
- 18. • Indications • All hernia require Sx unless they are eldely /unfit for Sx • Due to risk of complications of hernia • Preparation • Treat the predisposing cause • c/c cough constipation BPH • Anaesthesia • General • Spinal • Local } point block field block } anaesthesia of choice
- 19. • Position • Supine • Cleaning & draping the area • Incision • ½ ͚͛ aďoǀe & parallel to ŵedial to Ϯ/ϯrd of inguinal ligament • Structures cut • skin • 2 layers of superficial fascia • Ligate superficial epigastric & superficialexternal pudendal • External oblique along the direction of fibres directed towards apex of superficial inguinal ring • Ilioinguinal nerve is thus identified and preserved
- 20. Herniotomy • Search for sac (pearly white in colour) • Indirect – inside the spermatic cord anterolateral to it • Direct– outside the cord & posteromedial to it (therefore spermatic cord is not opened) • Incase of indirect hernia Incise cremasteric fascia & inrenal spermatic fascia • Expose the sac from fundus to neck separate from spermatic cord • Divide the fundus of the sac in the inguinal canal and reduce the contents by opening it and with fingers • Identify the neck with • Constriction /narrowness • Inferior epigastric A • Presence of extraperitoneal fat Alone is sufficient in childrens
- 22. • Transfix and ligate the neck by needle passing technique through the tissue to prevent slipping • Excise the redundant sac • Closure of the wound
- 23. Herniorraphy *(repair of posterior wall) • Indication for In children only when there is collagen vascular disease,severe anemia,severe malnutrition,CRF • ďassiŶi͛s repair • The conjoined muscle of the transversus abdominis and the internal oblique muscles is sutured to the inguinal ligament by 3-5 interrupted sutures (non absorbable suture) • Drawbacks • Undue tension to relieve it tanners slide operation (transverse incision on rectus sheath) • Recurrence due to approximation of muscle to a ligament & thick distant bites
- 24. • Modified ďassiŶi͛s repair • Conjoint tendon to inguinal ligament with continuous sutures • shouldice repair • 6 layers • 1st &2nd } double breasting of fascia transversalis • 3rd & 4th } approximate conjoint tendon to inguinal ligament in 2 layers • 5th & 6th } double breast external oblique aponeurosis • Spermatic cord is superficial more chance of trauma • Modified shouldice • Only 4 layers • 1st &2nd } double breasting of fascia transversalis • 3rd } approximate conjoint tendon to inguinal ligament in 1 layer
- 25. • Coopers ligament repair/mc vays repair • inguinal and femoral canal defects • The ĐoŶjoiŶed teŶdoŶ is sutured to Cooper͛s ligaŵeŶt froŵ the puďiĐĐuďiĐle laterally
- 26. Hernioplasty • Lichenstein tension free mesh repair • Rives repair • Preperitoneal mesh is kept with out suturing by incising transversalis fascia • GPRVS/giant prosthetic reinforcement of visceral sac/stoppas repair • By pfannensteil incision/midline vertical • Size of mesh • Breadth = distance B/W 2 ASIS -2cm • Length = b/w umbilicus to pubic symphysis • Desaradas technique • Dynamic repair
- 27. • Closure • External oblique is sutured with chromic catgut or silk. • Subcutaneous fat absorbable catgut suture. • Skin with silk. • Post -op • NPO fro 6-8 hours, oral fluids and soft diet later. • Analgesics • Antibiotics • Scrotal support if the dissection is more(complete hernia) • Suture removal after 7-10days. • Post-op complications • Haematoma • Wound infection • Severe peritonitis pubis • nerve entrapment causing pain.
- 28. Thank You