Totally Extraperitoneal Laparoscopic Repair of Inguinal Hernia

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Same as for open repair, but particularly advantageous in:
    • Bilateral
    • Recurrent
CONTRAINDICATIONS
  • Poor cardiorespiratory function
  • Inability to tolerate general anesthesia
  • Extensive previous or planned lower abdominal surgery, such as prostate surgery (relative contraindication)
EQUIPMENT
  • Anesthetic unit
  • Operating table
  • Instrument table
  • Diathermy
  • Laparoscopic unit
  • Two monitors
ANATOMY
  • A recurrent hernia is usually medial to the inferior epigastric vessels.
  • Boundaries of the triangle of doom:
    • Medial: Vas deferens
    • Lateral: Gonadal vessels
  • Contents of the triangle of doom: External iliac artery, external iliac vein, deep circumflex iliac vein, genital branch of genitofemoral nerve, femoral nerve
  • Boundaries of the triangle of pain:
    • Inferomedial: Gonadal vessels
    • Superolateral: Iliopubic tract
  • Contents of the triangle of pain: Lateral femoral cutaneous nerve, anterior femoral cutaneous nerve, femoral branch of genitofemoral nerve, femoral nerve
  • Circle of death (corona mortis): Formed by anastomosis of an aberrant obturator artery (or vein), arising from the external iliac or inferior epigastric with a normal obturator vessel arising from the internal iliac

PROCEDURE
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

POST-PROCEDURE
CARE

The patient should:

  • Take moderate oral analgesia for 1 to 4 days.
  • Return to normal activities and work in 2 weeks.
  • Avoid lifting more than 15 pounds for 2 weeks.
COMPLICATIONS
  • Bleeding
  • Nerve injury
  • Spermatic cord injuries
  • Bladder injuries
  • Bowel injury
  • Bowel obstruction
  • Wound infection
  • Seroma
  • Persistent pain
  • Recurrence
RESULT ANALYSIS

Although laparoscopic repair is associated with less postoperative pain and more rapid return to normal activities (including work), it takes longer to perform and may increase the risk of rare but serious complications.

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