Hernias2

38 %
63 %
Information about Hernias2

Published on January 5, 2009

Author: deepak15

Source: slideshare.net

Treatment of inguinal hernias Principles Review relative anatomy Operative methods Include new progress in hernia surgery

Principles

Review relative anatomy

Operative methods

Include new progress in hernia surgery

Principles of treatment: Adult: operative treatment Child under 1: the congenital inguinal hernia may spontaneously cure Patient with strong contraindications: non-operative treatment

Adult: operative treatment

Child under 1: the congenital inguinal hernia may spontaneously cure

Patient with strong contraindications: non-operative treatment

Non-operative management: Using some external support device or truss to maintain hernia reduction Only in the patients with strong contraindications of surgical operation

Using some external support device or truss to maintain hernia reduction

Only in the patients with strong contraindications of surgical operation

Operative treatment

Before operation: Any problems which could increase intraabdominal pressure, should be solved to prevent a recurrent hernia. Chronic cough Constipation Prostatic hyperplasia

Any problems which could increase intraabdominal pressure, should be solved to prevent a recurrent hernia.

Chronic cough

Constipation

Prostatic hyperplasia

Aim of Operation

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

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

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

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

The anterior wall:

the external oblique aponeurosis

Review: Anatomy of inguinal canal External oblique aponeurosis Conjoint tendon

Review: Anatomy of inguinal canal The transverse fascia Site for inguinal hernia

Operative techniques A. Simple high ligation of the sac used for child B. Repair of hernia C. Tension free Mesh repair D. Laparoscopic Repair

A. Simple high ligation of the sac

used for child

B. Repair of hernia

C. Tension free Mesh repair

D. Laparoscopic Repair

A. Simple high ligation of the sac: Ligate neck of hernia sac Isolate hernia sac Cut exteral oblique aponeurosis Removal of the sac

Ligate neck of hernia sac

Isolate hernia sac

Cut exteral oblique aponeurosis

Removal of the sac

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

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

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

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.

The anterior wall:

the external oblique aponeurosis

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

Before Bassini repair, cut transvers abdominal fascia and suture it overlaply

Decrease recurrent hernia effectively

The anterior wall:

the external oblique aponeurosis

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

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

The anterior wall:

the external oblique aponeurosis

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

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

The anterior wall:

the external oblique aponeurosis

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

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)

The anterior wall:

the external oblique aponeurosis

C. Tension free Mesh repair Use artificial materials Tesion free Low recurrent rate

Use artificial materials

Tesion free

Low recurrent rate

Tension free Mesh repair:

D. Laparoscopic Repair Shorter recovery time and less post-operative discomfort Used for bilateral hernias, recurrent hernia

Shorter recovery time and less post-operative discomfort

Used for bilateral hernias, recurrent hernia

Conclusion

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

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

Add a comment

Related presentations

Related pages

hernias2 - YouTube

hernias2 Iris Cornejo. Subscribe Subscribed Unsubscribe 15 15. Loading... Loading... Working... Add to. Want to watch this again later?
Read more

hernias 1 - YouTube

hernias 1 Iris Cornejo. Subscribe Subscribed Unsubscribe 15 15. Loading... Loading... Working... Add to. ... hernias2 - Duration: 1:12:00.
Read more

Open vs laparoscopic repair of secondary lumbar hernias: a ...

Devlin, HB Kingsnorth, A eds. Management of abdominal hernias2 Chapman & Hall Medical London 223 224 Google Scholar. 6. Geis, WP, Hodakowski, GT 1995 ...
Read more

Hernias Open Event in Brighton | Nuffield Health

Treatment options for hernias. Come along to our free open event at Nuffield Health Brighton Hospital to learn more and get expert advice. Book Now!
Read more

Inguinal Hernia Repair With Mesh Health And Social Care Essay

Inguinal Hernia Repair With Mesh Health And Social Care ... In USA exchequer costs approx 3.5 billion US$ per year for the treatment of inguinal hernias2.
Read more

Hernias | UAMSHealth

Different types of hernias Anyone can get one Hiatal hernias Surgical alternative Inguinal hernias These programs were first broadcast the week of January 28,
Read more

Is simple high ligation of the indirect sac standard ...

Is simple high ligation of the indirect sac standard treatment for primary pediatric indirect inguinal hernias? When, if at all, is a Marcy ...
Read more