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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This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or hefnias invented, except as authorized in writing by the AAFP. Surgical repair is usually advised because of the danger of incarceration and strangulation, particularly with femoral hernias. Like the anterior approach, the posterior approach provides excellent visualization of the areas of concern in herniorrhaphy. This is a corrected version of the article that appeared in print.
Most nerve entrapment syndromes are self-limited, respond to nonsteroidal analgesics and resolve with time. These chapters are a superb source for resident review prior to any hernia case. Recurrent inguinal hernia treated by classical hernioplasty. The reported recurrence rates for surgically treated hernias vary widely, depending on the length and jyhus of the follow-up period. Continue reading from January 1, Previous: A broad portion of mesh is stapled to span both hernia defects.
Inguinal hernia repair. The Nyhus posterior preperitoneal operation.
While these syndromes are often self-limited, surgery has been necessary to remove the staples that caused the neuralgia. Hernia repair using prosthetic mesh would be a henrias choice in the patient with a direct hernia or in the older patient with a longstanding hernia and attenuated fascia.
The techniques in herrnias 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. Postoperative convalescence also contributes to absence from the work force. This approach is well suited for outpatient herniorrhaphy performed with the patient nygus local anesthesia.
Surgical consultation is usually warranted if the parent or other caregiver reports that the child has had a groin bulge.
Nyhus and Condon’s Hernia, 5th Edition
Whether this will also be true for laparoscopic herniorrhaphy remains to be seen. The TAPP approach involves placing laparoscopic trocars in the abdominal cavity and approaching the inguinal region from the inside. The ilioinguinal nerve traverses the inguinal canal near the external inguinal ring and provides unilateral sensory innervation to the pubic region and the upper portion of the scrotum or the labia majora.
Randomized trial of modified Bassini versus Shouldice inguinal hernia repair. Fitzgibbons, Jr, MD, and A. This book is in readable print and reflects recent advances in a field significantly affected by research, the use of prostheses, and minimally invasive surgery. See My Options close. Some concern exists about the long-term safety of implanted prosthetic material, particularly the potential for infection or erosion.
Sheppard also completed a two-year research fellowship at the National Cancer Institute, Bethesda, Md. After the fetal testis has descended into the scrotum from the retroperitoneum, the processus vaginalis normally obliterates, thereby removing this potential for herniation. The group 3 hernia repairs Lichtenstein and Rutkow techniques use the same initial approach as open anterior repair.
Surg Clin North Am. Surgical repair of a hernia is not warranted in terminally ill patients with no evidence of incarceration. While laparoscopic herniorrhaphy tends to offer greater protection to the ilioinguinal and iliohypogastric nerves, injuries to the femoral or the lateral femoral cutaneous nerves have been reported.
Nyhus and Condon’s Hernia
nyhjs 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. Laparoscopic herniorrhaphy may be best reserved for treatment of recurrent or bilateral hernias.
Note that the hernia sac passes outside of the boundaries of Hesselbach’s triangle and follows the course of the spermatic cord. However, caution is advised, since a recent study 27 of open herniorrhaphy showed that return to work was most often determined by the patient’s type of insurance coverage rather than the type of procedure used to repair the hernia.
In the extremely rare patient with inguinal pain but no physical or sonographic evidence of inguinal herniation, computed tomographic scanning can be used to evaluate the pelvis for the presence of an obturator hernia. Injection of a long-acting local anesthetic along the course of these nerves is often helpful for diagnosing entrapment. To see the full article, log in or purchase access.
Thus, these hernias protrude directly through a defect in the inguinal canal floor, herniae than indirectly following the potential space of the processus vaginalis and the path of the spermatic cord. This is especially true in the case of femoral hernias, since the rigid borders of the femoral canal increase the risk of incarceration.
Surgical Options in the Management of Groin Hernias
Early studies showing acceptable outcomes for laparoscopic herniorrhaphy may reflect the same bias other procedure-focused centers have shown for open herniorrhaphy.
In such patients, additional open anterior repairs have a higher failure rate and an increased rate of complications.
The choice of technique nyjus on several factors, including the type of hernia, anesthetic considerations, cost, period of postoperative disability and the surgeon’s expertise. Excellent results have been reported for the posterior techniques, but problems related to suture tension remain. Studies conducted at nonspecialty centers probably provide a more accurate view of hernia repair techniques and results.
Wound hematomas and superficial wound infections are the most common problems, and they usually respond to conservative measures. It is probably best performed with the patient receiving regional or general anesthesia.