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Surgery for an Inguinal Hernia - Assignment Example

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I have no essay criteria.I have to critically anaylise the work in this title. This is a presentation to a group. I dont have time to prepare for this. Let me know if you need more information and I will try to help. Many thanks Melanie Lister. Harvard
Hernia is an abnormal protrusion of whole or a part of a viscus through an opening in the wall of the cavity in which it is contained…
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Surgery for an Inguinal Hernia
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Surgery for an Inguinal Hernia

It is important to note that herniotomy is not performed in direct inguinal hernia instead the sac is inverted here.
Herniotomy+ with reconstruction of posterior wall of inguinal canal by approximating conjoint muscle and tendon to recurved edge of inguinal ligament with non-absorbable suture such as silk, nylon or prolene. This is known as bassini's repair. Silk is usually avoided as if it becomes infected it will cause sinuses.
Suture must be done with out tension as this will lead to cutting of the muscle or ligaments from their sutures. To avoid the tension one may add tanner's slide operation where a curved release incision is made in anterior rectus sheath above the conjoint tendon so that the lateral leaf of the incision at once retracts down and makes the tense conjoint tendon loose.
IV. Willy - Andrews modifications: Upper flap of external oblique aponeurosis is sutured down to inguinal ligament as an added posterior layer and lower flap is brought over the cord and sutured to upper flap, so that cord was sandwiched between two layers of external oblique.
IV. Upper and lower flap of transversais facia are sutured in double bresting manner by using non-absorbable sutures like 34-gauge stainless steel wire, poyamide or polypropylene. This is the first layer of shouldice repair.
Herniotomy+ reinforcement of posterio...
Criticism for bassini's Herniorrhaphy:
I. It is a repair with tension
II. Conjoint tendon and inguinal ligament approximation is not physiological.

Modification added to bassini's repair have been advocated:
I. Repair of stretched internal inguinal ring on its middle side if it is too wide - in indirect hernia.
II. Plication of fascia transversalis - direct hernia.
III. Halstead modification: Spermatic cord is exteriorised by suturing the external oblique aponeurosis behind it. Thus cord remains insubcutaneous.
IV. Willy - Andrews modifications: Upper flap of external oblique aponeurosis is sutured down to inguinal ligament as an added posterior layer and lower flap is brought over the cord and sutured to upper flap, so that cord was sandwiched between two layers of external oblique.

Indication: adults with week abdominal musculature.

Note: Irrespective of type of hernia, Mesh repair (Lichpenstein) is recommended today as first line of repair.

B. Shouldice:
I. It is the most popular tensionless method where only local tissues are used.
II. After opening the inguinal canal herniotomy is done.
III. Transversalis fascia which forms the posterior wall is incised from internal ring till pubic tubercles.
IV. Upper and lower flap of transversais facia are sutured in double bresting manner by using non-absorbable sutures like 34-gauge stainless steel wire, poyamide or polypropylene. This is the first layer of shouldice repair.
V. The second layer is like bassini's where conjoint tendon is sutured to inguinal ligament by using non-absorbable sutures.
VI. The third layer is completed by suturing upper flap of external oblique aponeurosis to the inguinal ligament.
VII. The results have been good in shouldice hands and operation needs expertise.

3. ... Read More
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