Hernias2
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This document discusses the treatment of inguinal hernias. It reviews the anatomy of the inguinal canal and covers different operative techniques. For adults, operative treatment is preferred while hernias in children under 1 may resolve spontaneously. Non-operative management uses external supports. Operative techniques include high ligation of the sac, open hernia repairs that reinforce the posterior or anterior wall like Bassini and Ferguson, tension-free mesh repairs, and laparoscopic repair.
Hernias2
- 1. Treatment of inguinal hernias Principles Review relative anatomy Operative methods Include new progress in hernia surgery
- 2. Principles of treatment: Adult: operative treatment Child under 1: the congenital inguinal hernia may spontaneously cure Patient with strong contraindications: non-operative treatment
- 3. Non-operative management: Using some external support device or truss to maintain hernia reduction Only in the patients with strong contraindications of surgical operation
- 5. Before operation: Any problems which could increase intraabdominal pressure, should be solved to prevent a recurrent hernia. Chronic cough Constipation Prostatic hyperplasia
- 7. Review: Anatomy of inguinal canal From the internal inguinal ring to the external inguinal ring, 4-5 cm long Inside the canal Male: the spermatic cord Female: the round ligament of the uterus
- 8. Review: Anatomy of inguinal canal The superior wall(roof) Conjoint tendon (the arcing edge of the fusing of the internal oblique abdominal muscle and the transverse abdominal muscle) The inferior wall(floor) The inguinal ligament The anterior wall The external oblique aponeurosis Skin and superficial fascia The posterior wall The transverse fascia Roof ： The conjoint tendon The anterior wall: the external oblique aponeurosis The posterior wall: the transverse fascia Floor ： The inguinal ligament The spermatic cord
- 9. Review: Anatomy of inguinal canal External oblique aponeurosis Conjoint tendon
- 10. Review: Anatomy of inguinal canal The transverse fascia Site for inguinal hernia
- 11. Operative techniques A. Simple high ligation of the sac used for child B. Repair of hernia C. Tension free Mesh repair D. Laparoscopic Repair
- 12. A. Simple high ligation of the sac: Ligate neck of hernia sac Isolate hernia sac Cut exteral oblique aponeurosis Removal of the sac
- 13. B. Repair of hernia: herniorrhaphy High ligation of the sac Repair and reinforcement the inguinal canal wall reinforce the posterior wall of the inguinal canal : Bassini Shouldice Halsted Mcvay reinforce the anterior wall of the inguinal canal: Ferguson
- 14. Bassini repair: Approximates and sutures the arcing edge of the conjointed tendon to the inguinal ligament beneath the spermatic cord Leaves the spermatic cord between the internal oblique muscle and the external oblique aponeurosis. Roof ： Conjoint tendon The anterior wall: the external oblique aponeurosis The posterior wall: the transverse fascia Floor ： The inguinal ligament The spermatic cord
- 15. Shouldice repair: Before Bassini repair, cut transvers abdominal fascia and suture it overlaply Decrease recurrent hernia effectively Roof ： Conjoint tendon The anterior wall: the external oblique aponeurosis The posterior wall: the transverse fascia Floor ： The inguinal ligament The spermatic cord
- 16. Halsted repair: Place the external oblique aponeurosis beneath the cord , but otherwise resembles the Bassini repair. Leaves the spermatic cord under the skin and subcutaneous tissue Used in older men Roof ： Conjoint tendon The anterior wall: the external oblique aponeurosis The posterior wall: the transverse fascia Floor ： The inguinal ligament The spermatic cord
- 17. McVay repair: Brings the arcing edge of the conjointed tendon posteriorly and inferiorly to Cooper’s ligament and suture them For big hernia, recurrent hernia, femoral hernia Roof ： Conjoint tendon The anterior wall: the external oblique aponeurosis The posterior wall: the transverse fascia Floor ： The inguinal ligament The spermatic cord The cooper’s ligament
- 18. Ferguson repair: Approximate and suture the arcing edge of the conjointed tendon to the inguinal ligament above the spermatic cord Leave the spermatic cord beneath the internal oblique muscle and the external oblique aponeurosis (the repaired anterior wall) Roof ： Conjoint tendon The anterior wall: the external oblique aponeurosis The posterior wall: the transverse fascia Floor ： The inguinal ligament The spermatic cord
- 19. C. Tension free Mesh repair Use artificial materials Tesion free Low recurrent rate
- 20. Tension free Mesh repair:
- 21. D. Laparoscopic Repair Shorter recovery time and less post-operative discomfort Used for bilateral hernias, recurrent hernia
- 22. Conclusion
- 23. Operative techniques A. Simple high ligation of the sac B. Repair of hernia reinforce the posterior wall of the inguinal canal : Bassini Shouldice Halsted Mcvay reinforce the anterior wall of the inguinal canal: Ferguson C. Tension free Mesh repair D. Laparoscopic Repair