Please enable JavaScript.
Coggle requires JavaScript to display documents.
Inguinal Hernia Repair: Hernioplasty (Laparoscopic Repair (Disadvantages,…
Inguinal Hernia Repair: Hernioplasty
6% of all general surgical operations
15% of all general surgical outpt. consultations
Open: Lichtenstein Repair
Can be performed under LA or GA
1. Enter inguinal canal
Skin incised along Langer lines from external ring ~5cm towards ASIS.
Incise Camper’s (fatty), then Scarpa’s (membranous)
Incise external oblique to enter inguinal canal.
2. Mobilise and retract spermatic cord
3. Identify and dissect hernial sac
Dissect hernial sac off cord
May incise carefully and check for viscera
Invaginate sac into peritoneal cavity.
4. Cover defect and posterior wall w/ tension-free mesh
Laparoscopic Repair
2 Main Repair Techniques
Totally Extra Peritoneal (TEP)
Use balloon to blunt dissect extraperitoneal
space posterior to recti.
Reduce hernial sac and cover defect w/ mesh
Trans-Abdominal Pre-Peritoneal (TAPP)
Mesh placed through incision in peritoneum
Advantages
Allows ID and repair of contralateral hernia which may or may not have been diagnosed.
Quicker recovery
↓ acute pain
↓ complications
↓ chronic pain
Disadvantages
Technically challenging
Longer operation
More expensive
Complications
Early
Urinary retention
Haematoma / seroma formation: 10%
Infection: 1%
Intra-abdominal injury (lap)
Late
Recurrence (<2%)
Ischaemic orchitis: 0.5%
secondary thrombosis of pampiniform plexus
Chronic groin pain / paraesthesia: 5%
Post-op
Day cases unless co-morbidities
Discharge w/ mild analgesics and mild laxatives
Return to work @ 1-2wks