Surg Clin North Am. Dec;78(6) Inguinal hernia repair. The Nyhus posterior preperitoneal operation. Patiño JF(1), García-Herreros LG, Zundel N. The Nyhus Posterior Preperitoneal Operation The repair of inguinofemoral hernias constitutes the most widely performed general surgical procedure. Adapted with permission from Nyhus LM, Klein MS, Rogers FB. Inguinal hernia. Curr Probl Surg ;
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Early in the development of the technique, hernias were repaired by placing a large piece of mesh over the entire inguinal region on top of the peritoneum.
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In patients who have symptoms suggestive of recurrent herniation but no clinical herniaa, the diagnosis can usually be obtained through sequential serial examinations and the judicious use of imaging modalities. Injection of a long-acting local anesthetic along the course of these nerves is often helpful for diagnosing entrapment.
Most classification systems take into account the location of the defect direct, indirect or femoralthe size of the defect and whether or not the herniation is recurrent. Sign in to make a comment Sign in to your personal account. Tension-free repair can be performed using any type of anesthesia. Approximately 50 percent of hernia recurrences do not present until at least five years after the original herniorrhaphy.
The choice of technique depends on several factors, including the type of hernia, anesthetic considerations, cost, period of postoperative disability and the surgeon’s expertise. Herniias development of this type of hernia requires a potential hernia sac, which is provided by the processus vaginalis.
Most laparoscopic hwrnias repairs are being performed by skilled laparoscopic surgeons in specialty centers. Staples are not used in proximity to neurovascular structures. Group 1 hernia herniss Bassini, McVay and Shouldice techniques involve opening the external oblique aponeurosis and freeing the spermatic cord.
Nyhus and Condon’s Hernia
Except for pain or a dull dragging sensation in the groin, the common reducible inguinal hernia usually does not cause significant symptoms. McVay open anterior repair. Nhus iliohypogastric nerve passes superior to the internal inguinal ring and provides sensory innervation to the skin superior to the pubis. Lastly, there nygus bonus chapters that discuss ventral incisional, pediatric, and diaphragmatic hernias. Performance of the laparoscopic TAPP repair also exposes patients to potential intra-abdominal injury and late adhesion formation.
This mesh allows the hernia to be repaired without tension being placed on the surrounding fascia Figure 7. This article reviews the available surgical options for herniorrhaphy and the possible complications of these procedures.
Surgical Options in the Management of Groin Hernias
Mechanisms of hernia recurrence after preperitoneal mesh repair. Specialty centers continue to report very low complication and recurrence rates in large series of patients. A femoral hernia can occur as a result of elevated intra-abdominal pressure. Bilateral hernias may also be addressed simultaneously, using either an open or a laparoscopic procedure.
Recurrence is the most common long-term complication of inguinal herniorrhaphy. Create a free personal account to make a comment, download free article PDFs, sign up for alerts and more. Consequently, the bowel or vascular hernixs may be injured during the procedure Figure 8. Thus, an indirect hernia is the result of two conditions: The most common hernia in both sexes is the indirect inguinal hernia. This is a wonderful source of information for the young surgeon in training, as it makes one of the most complex areas of the hdrnias easy to grasp and understand.
A randomized prospective trial.
Get immediate access, anytime, anywhere. See My Options close. Surgical consultation is usually warranted if the parent or other caregiver reports that the child has had a groin bulge. Information from references 5and 10 through In some series, the recurrence rate following repair of a recurrent hernia is as high as 30 percent, which is significantly greater than the recurrence rate after initial repairs.
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Inguinal hernia repair. The Nyhus posterior preperitoneal operation.
Either general or regional spinal anesthesia may be used in these patients. Postoperative convalescence also contributes to absence from the work force. With very large defects or with fascia of marginal quality, the tension of the sutures can lead to recurrence. This anatomic landmark is bounded by the rectus abdominis muscle medially, the inguinal ligament inferiorly and the inferior epigastric vessels laterally.
In some series, the laparoscopic approach has been 40 percent more costly than other approaches.
Another chapter touches on several up-to-date laparoscopic and endoscopic techniques. Patients occasionally respond poorly to a general anesthetic and require overnight hospitalization because of nausea, excessive sedation or urinary retention.
These chapters are a superb source for resident review prior to any hernia case. Three major types of open repair are currently used, and laparoscopic techniques are herhias employed. The techniques in the open anterior repair group differ somewhat in their approach to reconstruction, but they all use permanent sutures to approximate the surrounding fascia and repair the floor of the inguinal canal.
Topics include chronic pain after hernia repair, cord and testicular complications, wound infections, and neuralgia. The lifetime risk of inguinal herniation is approximately 10 percent.