Definition
Type of Hernia
risk factor
pathophysiology
diagnostic procedure
physical assessment
management for hernia
Nursing Diagnosis
Health Education
Definition
Type of Hernia
risk factor
pathophysiology
diagnostic procedure
physical assessment
management for hernia
Nursing Diagnosis
Health Education
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #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
• In this video today, I have discussed Open Inguinal Hernia Repair.
• 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.
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
Search Results
Featured snippet from the web
A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a number of types. Most commonly they involve the abdomen, specifically the groin. Groin hernias are most commonly of the inguinal type but may also be femoral
Inguinal hernia presentation
by Shariatyfar MD
based on schwartz principles of surgery 11th edition
Qom university of medical sciences
winter 2017
email me at Mohammadali.shariatyfar@hotmail.com for Download
Good luck
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #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
• In this video today, I have discussed Open Inguinal Hernia Repair.
• 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.
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
Search Results
Featured snippet from the web
A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a number of types. Most commonly they involve the abdomen, specifically the groin. Groin hernias are most commonly of the inguinal type but may also be femoral
Inguinal hernia presentation
by Shariatyfar MD
based on schwartz principles of surgery 11th edition
Qom university of medical sciences
winter 2017
email me at Mohammadali.shariatyfar@hotmail.com for Download
Good luck
Hernias (as an inguinal hernia, umbilical hernia, or spigelian hernia) in which an anatomical part (as a section of the intestine) protrudes through an opening, tear, or weakness in the abdominal wall musculature.
Approximately 75% of abdominal wall hernias occur in the groin.
The lifetime risk of inguinal hernia is 27% in men and 3% in women.
And hence Of inguinal hernia repairs, 90% are performed in men, and 10% are performed in women.
The incidence of inguinal hernia in men has a distribution, with peaks before the first year of life and after age 40.
Indirect inguinal and femoral hernias occur more commonly on the right side.
This is attributed to a delay in atrophy of the processus vaginalis after the normal slower descent of the right testis to the scrotum during fetal development.
The predominance of right-sided femoral hernias is thought to be caused by the tamponading effect of the sigmoid colon on the left femoral canal
The prevalence of hernias increases and the likelihood of strangulation and need for hospitalization increase with aging.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
3. Introduction
• Inguinal hernia is a protrusion of a
peritoneal sac through a
muscluoaponeurtoic barrier in inguinal
area.
4. Anatomy of Inguinal canal
• Inguinal canal is a tunnel that traverses the layers of the
abdmonial wall musculature, bounded on the lateral
deep aspect by an opening in the transversalis
fascia/transversus abdminis muscle which is called
internal or deep inguinal ring.
• It travels along the fused edges of the transversus
abdmoinis/internal oblique/inguinal ligament and iliopubic
tract posteriorly and layers of the external oblique
musculature anteriorly, ending on the medial superficial
aspect at an opening in the external oblique aponurosis
which is called external or superficial inguinal ring.
5. • Ingunial canal is 4-6cm long
• Located in the anteroinferior of the pelvic
basin
• It is cone shaped.
• Base is directed superolaterally and Apex
inferomedially.
6. • The inguinal canal houses spermatic cord
in males and round ligament in female.
• It is subject to hernia formation primarily
due to decreased mechanical integrity of
the internal ring and/or transversalis
fascia,allowing intra-abdominal contents to
encroach into this space and form the
characteristic bulge of the groin hernia.
7. • Hernia formation in inguinal canal can be prevented by
certain defence mechanism of inguianl canal which are:
• Obliquity of inguinal canal
• Arching of conjoint tendon
• Shutter mechanism of internal oblique
• Ball valve mechanism due to contraction of cremasteric
muscle which plugs to superficial ring
• When external oblique muscle contracts, intercrural
fibers of superifical ring appose, causing “slit-valve
mechanism”
• Hormones
8.
9. Types of Inguial Hernia
• Direct Hernia: It occurs as a result of
weakness in the posterior wall of the
inguinal canal, which is usually a result of
attenuation of the transversalis fascia. The
hernia sac protruds through Hesselbach
triangle, whivh is the space bounded by
the inferior epigastric artery, the lateral
edge of rectus sheath and the inguinal
ligament.
10. • Indirect hernias: These passes through
the internal inguinal ring lateral to the
inferior epigastric vessels and Hesselbach
triangle and follow the spermatic cord in
males and round ligament in females.
• Pantaloon hernia: when both direct and
indirect hernias co-exist.
11. Variants of Inguial hernia
• Sliding hernia: usually indirect hernia, it
denotes that a part of the wall of the hernia sac
is formed by an intra-abdominal viscus usually
colon sometimes bladder.
• Richter Hernia: A portion of ( rather than the
entire circumference) of the bowel wall is
incarcerated.
• Littre Hernia: which contains Meckel
Diverticulum
• Amyand Hernia: An inguinal hernia that
contains the appendix.
12.
13. Epidemiology
• The true incidence and prevalence of inguinal hernia worldwide is
unknown.
• The male to female ratio is greater than 10:1.
• The lifetime prevalence is estimated to be 25% in men and 2% in
women.
• Two third of inguinal hernias are indirect whereas nearly two-thirds
of recurrent hernias are direct.
• About 10% of inguinal hernias will become incarcerated and a
portion of these may become strangulated.
• Recurrence rates after surgical repair are less then 1% in children
and vary in adults related to the method of repair.
• Laproscopic studies have reported rates of contralateral defects as
high as 22% with 28% of these going on to become symptomatic
during short term followup.
14. Etiology
• Mutifactorial i.e genetic, environmetal, metabolic or hormonal
• Weakness in abdominal wall musculature
• Presumed causes of groin hernias are:
• Coughing COPD Obesity Straining
• Constipation Prostatism Pregnancy
• Birth weight less than 1500g
• Family history of hernia
• Congenital connective tissue disorders
• Defective collagen synthesis
• Previous incision
• Arterial aneurysum
• Cigarette smoking
• Heavy weight lifting
• Ascities
15. Clinical Presentation
• Most inguinal hernias present as an intermitted bulge
that appears in the groin. In males, it may extend into
scrotal sac.
• Symptoms are usually related to exertion or long peroid
standing.
• The patient may complain of unilateral discomfort.
• In infants and childrens, a groin bulge is often noticed by
caregivers during episodes of crying or defecation.
• In rare cases, groin hernia may present as intestinal
obstruction.
16. Physical Examination
• The main diagnostic maneuver for inguinal
hernias is palpation of the inguinal region.
• The patient is best examined while standing or
straining.
• Hernias manifest as bulges with smooth,rounded
surfaces that become more evident with
straining.
• A cough impulse is normally palpable, and bowel
sounds can often be heard within the hernia on
ascultation. If there is no visible swelling, a
cough impulse is sought with the patient
standing.
17. • In order to differentaite between indirect
and direct hernia, the best technique is to
reduce the hernia with the patient in
supine position and place a thumb over
deep ring(ring occlusion test). Ask the
patient to cough, it should control the
hernia (no bulge) only if it is of indirect
variety
18. Classification
• Many classification systems have been devised
for ingunial hernias, few of them are listed below
• Gilbert classification
• Nyhus Classification
• Bendavid classification
• Halverson and McVay Classification
• Ponka’s Classification
• European Classification
19.
20.
21. Investigations
• Diagnosis of ingunial hernia is clinical but certain
investigations are performed in certain
circumstances
• Ultrasound abdomen and pelvis: It defines
defect and its contents. In old age, to look for
BPH, its size and to calculate post-voidal
volume. And to find any mass.
• CT scan: Its helpful in complex incisional hernia
determining the number and size of muscle
defects, identifiying the contents as well as
intraabdominal pathology.
22. • MRI: It is helpful in diagnosing sportsman’s groin
where pain is the presenting feature and to
distinguish occult hernia from orthopedic injury.
• Laproscopy: useful to identify occult
contralateral hernia.
Herniography: It can be performed in suspected
hernia when clinical diagnosis is unclear. This
procedure is done under floruoscopy following
injection of contrast medium in peritoneum.
Frontal and oblique radiographs are taken with
and without increased intra-abdominal pressure.
23.
24. Treatment
Principle of hernia repair
1) Reduction of hernia content into the abdominal
cavity with removal of any non-viable tissue and
bowel repair if necessary.
2) Excision and closure of a peritoneal sac if
present or replacing it deep to the muscle.
3) Reapproximation of the walls of the neck of the
hernia if possible
4) Permanent reinforcement of the abdominal wall
defect with sutures or mesh.
5) Tension Free.
26. Conservative approach
• Truss: A truss is a surgical appliance
which provides support for the herniated
area, using a pad and belt arrangement to
hold it in the correct position, just when it
is put on before moving from bed.
– It is not curative
– Hernia should be reducible
– Contraindicated in case if irreducible hernia,
undesended testies, associated huge
hydrocele
29. Herniotomy
• It is performed for indirect ( congenital ) hernias.
• It is performed in pediatric age group and young adults.
• STEPS:
Classically an oblique skin incison is made parallel and 1-1.5cm above the
medial two third of the inguinal ligament.
After dividing the superficial fascia and securing hemostasis, the external obliqu
aponeurosis and the superficial inguinal ring are identified.
The external oblique aponeurosis is incised in the line of its fibers and this inguinal
canal is opened.
The contents of the inguinal canal (cord with its contents) can be visualized.
The sac of indirect hernia is present inside the covering of cord and lies lateral
to the inferior epigastric artery. Cord is lifted off the inguinal canal.
The sac is freed all around upto deep ring. The visualization of extraperitoneal
fats confirms the location of deep ring.
The neck of sac is transfixed and sac is excised. In cases where there is large
hernial sac reaching upto the scrotum. It might not be possible to separate the sac
completely. In these circumstances, the distal end of the sac can be left as such.
30. Henriorraphy
• It is strenthening of posterior wall of
inguinal canal.
• It is indicated in young adults with good muscle
tone.
• Those having weak posterior wall
• Dilated internal ring.
36. Halstead’s Repair
• In this repair, (which otherwise resembles
Bassini ) external oblique aponeurosis is used to
strengthen the postrior wall.
• This exteriorzies the spermatic cord, placing it
beneath the layers of abdominal wall fascia.
• This technique is not appreciated because of the
high incidence of hydrocoels and testicular
atrophy as well as recurrence postoperatively.
37.
38. Ferguson Repair
• In this,the arcing edges of conjoint tendon
is approximated and sutured to the
inguinal ligamant above the spermatic
cord.
• It leaves the spermatic cord beneath the
internal oblique muscle and the external
oblique aponeurosis.
39. McVay Repair
• In this procedure, interrupted suture is
applied between transversalis fascia to
copper’s ligament starting from public
tubercle medially towards femoral sheath
and later continued as suture repair
between transversalis fascia and iliopublic
tract laterally upto enterence of cord.
• It covers all three groin defects- indirect,
direct and femoral.
40.
41. Darning Repair
• In this, continuous intervening network of
non-absorbable sutures are plaaced
between conjoint and inguinal ligament to
give good support to posterior wall of
inguinal hernia.
42.
43. Hernioplasty
• Herniotomy
• Strengthening of the posterior wall of
inguinal canal with autologous tissue or
foreign material.
• Use of Prolene Mesh to bridge the gap
between inguinal ligament and conjoint
tendon.
45. Lichtenstein’s Tension Free
• Prolene mesh is taken and fixed in the
inguinal ligament
• First bite is taken in the periosteum of
public tubercle and fix the mesh to a point
beyond the deep ring.
• Fix the mesh with inguinal ligament and
conjoint tension used 1/0 or 2/0 prolene
without tension.
• It is used in all types of inguinal hernia.
46. Mesh can be used..
• To bridge a defect: simply fixed over the
defect as tension free patch.
• To plug a defect: a plug of mesh is pused
into the defect.
• To augment a repair: the defect is closed
with sutures and the mesh is added for
reinforcement.
47. Types of Mesh
• Synthetic Mesh
– Polymer of polypropylene, polyester or
polytetrafluroethylene (PTFE)
– Non absorbable and provoke little tissue
reaction.
– Hydrophobic nature and monofilament
microstructure of polypropylene impede
bacterial ingrowth.
48. Type of Mesh
• Biological Mesh
– Sheets of sterilized, decellularised, non
immunogenic connective tissue
– Provide a scaffold to encourage neovascular
ingrowth and new collagen deposition
– Host enzymes eventually break down the
biological implant which is replaced and
remodelled with fibrous tissue.
– It is expensive.
49. Type of Mesh
Absorbable Mesh:
Also synthetic absorbable meshes, such as
those made of polyglycolic acid fibers.
Used in temporary abdominal closure and
to butre sutured repairs
No role in hernia repair as they absorb and
induce minimal collagen deposition.
50. Positioning of Mesh
• Onlay – it is just outside of the muscle in
the subcutaneous space.
• Inlay – it is placed within the defect, only
applies to mesh plugs in small defects
• Sublay – its in between fascial layers in
the abdominal wall, intrapariteal
• Immediaterly extraperitoneally – against
muscle or fascia
• Intraperitoneally.
51. Type of Mesh
Tissue Separating mesh:
It is used Intraperitoneally
It is used on Different surfaces, one being
sticky and another slippery
It has adherence and host tissue in growth
is required on the pariteal side of the mesh
Bowel side needs to prevent adhesion to
the bowel.
52. Other repairs using Mesh
• Patch & Plug Technique involves
placement of a preformed mesh plug in
the hernia defect that is sutured to the
facial margins of defect.
• Kugel’s repair is a preperiotoneal repair
in which a preformed mesh with a stiff ring
around the edges is placed in the
preperitoneal space.
53. Stoppa’s Repair
• The Stoppa Repair is a tension-free type of hernia repair. It is
performed by wrapping the lower part of the pariteal peritonium with
prosthetic mesh and placing it at a preperitoneal level over
Fruchaud's myopectineal orifice. It was first described in 1975 by
Rene Stoppa. This operation is also known as "giant prosthetic
reinforcement of the visceral sac" (GPRVS).
•
This technique has met particular success in the repair of
bilateral hernias, large scrotal hernias, and recurrent or
rerecurrent hernias in which conventional repair is difficult and which
carries a high morbidity and failure rate.
• The totally extra-peritoneal repair (TEP) uses exactly the same
principles as the Stoppa repair, except that it is
performed laparoscopically.
54. Laparoscopic Mesh Repair
• TAPP
Transabdominal Preparitoneal
Procedure
TEP
Total Extraperitoneal Procedure
55. TEP Repair
• It is more popular then TAPP.
• Through subumbilical incision (10mm)
extraperitoneal space is reached.
• After CO2 insufflation, another 5mm port is
created 4cm below the 1st
port in the midline, 3rd
port on the same line or RIF.
• Dissection is carried downwards carefully, then
medially upto public tubercle, iliopectneal line,
laterally to iliac vessels and inferior epigastric
vessels.
56. TEP Repair
• Once adequate spce is dissected 15 x
15cm mesh is placed and spread.
• Mesh may be sutured to iliopectinal
ligament.
• Displacement of mesh is not seen.
• Another side can be done on single
setting.
57. TAPP Repair
• Used in large indirect or irreducible inguinal hernia.
• Ports created
• Contents of hernia is reduced
• Hernial sac dissected in preperitoneal plane after making
horizontal incision at the upper part of the sac opening.
• Once sac is dissected & excised, prolene mesh of
15x10cm size or smaller is placed in preperitoneal
space.
• It is fixed with pubic bone using tacks.
• Peritoneum is closed with continuous prolene suture.
58. Compliations- Intra operative
• Injury to blood vessels ( inferior epigastric &
femoral.
• Injury to bowel and bladder
• Injury to ilioinguinal & iliohypogastric nerves
• Injury to cord structues
59. Complications – Immediate Post
Operative
• Urine retention
• Hematoma formation
• Infection
• Seroma
• Periosteitis of public tubercle
• Post herniorrhaphy hydrocele
60. Complications - Late
• Recurrence
– Recurrence rate
Bassini’ repair – 10%
Shouldice repair – 1%
Hernioplasty – 1 t0 3%
Other methods – 1 to 5%
• Testicular atrophy if testicular artery is
demaged
• Obstruction