Open Repair of Inguinal Hernia

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  • Symptoms
  • Incarceration/strangulation
  • Femoral hernias
  • Reversible causes of increased intra-abdominal pressure
  • Active infection
  • Anesthetic equipment
  • Operating table
  • Instrument table
  • Electrocautery device
  • Boundaries (walls) of the inguinal canal:
    • Anterior: External oblique aponeurosis
    • Posterior (floor): Transversalis fascia and transversus abdominis aponeurosis
    • Superior: Internal oblique and transversus abdominis musculoaponeurosis
    • Inferior: Inguinal ligament and lacunar ligament
    • Medial: External (superficial) inguinal ring
    • Lateral: Internal (deep) inguinal ring
  • Boundaries of the femoral canal triangle:
    • Anterior: Iliopubic tract
    • Posterior: Cooper ligament
    • Lateral: Femoral vein
    • Apex: Pubic tubercle
  • Boundaries of the Hesselbach triangle:
    • Superolateral: Inferior epigastric vessels
    • Medial: Rectus sheath
    • Inferior: Inguinal ligament
  • Components of the spermatic cord:
    • Cremasteric muscle fibers
    • Gonadal artery and accompanying veins
    • Genital branch of the genitofemoral nerve
    • Vas deferens
    • Cremasteric vessels (branches of inferior epigastric vessels)
    • Lymphatic vessels and processus vaginalis
  • Important nerves:
    • Iliohypogastric and ilioinguinal
    • Genital branch of the genitofemoral nerve
    • Lateral femoral cutaneous
  • A direct hernia is medial to the inferior epigastric vessels; an indirect hernia is lateral to the inferior epigastric vessels.

Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Moderate oral analgesia for 1 to 4 days
  • Slow ambulation and light eating on the night of surgery
  • Progressive increase in activity
  • Avoid immersing the wound in water for 1 week
  • Wound infection
  • Sensory nerve transaction manifested as numbness
  • Nerve entrapment manifested as chronic groin pain
  • Ischemic orchitis and testicular atrophy
  • Injury to the vas deferens
  • Injury to intra-abdominal viscera
  • Hernia recurrence

Numerous comparative randomized trials have clearly demonstrated the superiority of the tension-free mesh repair over the traditional tissue approximation method.

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