TREATMENT OF INGUINAL HERNIA

INDIRECT HERNIA
  • Always surgery
IN INFANTS:
  • Herniotomy 
IN ADULTS:
  • Herniotomy[excision of hernial sac]+Herniorrhaphy/ Hernioplasty[strengthening of the posterior wall of inguinal canal either by repair or mesh]
REPAIR MAY BE:
PURE TISSUE REPAIR

  • Shouldice,Mac Vay,Modified bassini
PROSTHETIC REPAIR
  • Lichtenstein,Rives,Gilbert,Stopa,TEP,TAPP
Anterior Repair
  • Through anterior inguinal approach
  • Bassinis, Shouldice,Mac Vay, Lichtenstein, Rives peritoneal repair
Posterior Repair
  • Through Supra Inguinal Pre peritoneal Approach
  • Nyhus repair, Stoppas, TEP, TAPP, Kugel’s Repair
HERNIOTOMY
  • Indication:
  • Congenital hydrocele 
  • Anesthesia-spinal or GA
  • After cleaning and draping, skin is incised-1.25 cm above and parellel to the medial 2/3 of inguinal ligament.
  • Sup fascia(camper’s and scarpa’s fascia)are incised.
  • Ext oblique aponeurosis is incised.
  • Visualize the inguinal ligament.
  • Illio inguinal nerve is safeguarded.
  • Cremasteric muscle is opened, cord structures are dissected.
  • Sac which is ant and lat to the cord is identified and its pearly white in colour.
  • Dissection usually starts from the fundus and extented towards the neck which is identified by extra peritoneal fat
  • Finger is passed to release any adhesions
  • Surgery can be done using laparoscopy
  • Sac is twisted and transfixed using absorbable suture and is excised distally
  • Non-absorbable mesh is used for hernia surgery.
  • During repair of indirect inguinal hernia, while releasing the constriction at the deep inguinal ring, the surgeon takes care not to damage Inferior epigastric arterySpermatic cord
Exam Question
  • During surgical repair of hernia, the sac of a strangulated inguinal hernia should be opened at Fundus
  • Congenital hydrocele is treated by herniotomy
  • Hernia in children is treated with herniotomy
  • Absorbable mesh should not be used for surgery
  • Surgery can be done using laparoscopy
  • A pt. operated for direct inguinal hernia developed anethesia at the root of the penis and adjacent part of the scrotum the nerve likely to be injured is Ilioinguinal nerve During repair of indirect inguinal hernia, while releasing the constriction at the deep inguinal ring, the surgeon takes care not to damage Inferior epigastric arterySpermatic cord
  • Most important step in the repair of an indirect inguinal hernia is Narrowing of the internal ring

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