Open Inguinal Hernia Repair (Lichtenstein) - Indirect Hernia
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Open Inguinal Hernia Repair (Lichtenstein) - Indirect Hernia |
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Video From Incision |
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This Video Uploaded At 11-02-2022 15:00:21 |
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This Open Inguinal Hernia Repair (Lichtenstein) - Indirect Hernia course will teach you repositioning of the hernia sac. View the full course for free by signing up on our website: https://www.incision.care/
SURGICAL OBJECTIVES
The main goal of the current inguinal hernia repair procedures is the removal of the hernia sac and the tension free reinforcement of the posterior wall of the inguinal canal. In certain cases, especially in open surgery, nerve resection is inevitable. In those cases pragmatic nerve resection is performed, without increasing the risk of chronic pain. The available surgical alternatives can be generally subdivided in non-mesh and mesh (open mesh repair or Lichtenstein and laparoscopic mesh repair). Non-mesh or tissue repair:
- Bassini procedure: approximation of the conjoined tendon (transverse abdominal muscle and internal oblique muscle) and the inguinal ligament.
- Shouldice procedure: a layer reconstruction of the transversalis fascia, currently the preferred method if a mesh method is not possible.
- Sac resection in case of children (0-18 years).
For a mesh-based repair it is common in high resource settings to use a commercial mesh. These are typically made of polypropylene or polyester. The cheaper mosquito-net counterparts are most commonly used in low resource settings. Alternatively, watchful waiting in case of minimal or asymptomatic inguinal hernias is safe since the risk of hernia complications remains low. Although most patients will develop symptoms and will eventually need surgery.
APPROACHES
The inguinal hernia repair, may be performed using an open or laparoscopic approach.
- The open approach is known as the Lichtenstein repair with mesh placement in front of the transversalis fascia. Currently, studies are being conducted regarding another open approach, known as the transrectus sheath preperitoneal technique (TREPP). This technique might be a good alternative for the Lichtenstein technique.
- The most commonly used laparoscopic techniques for inguinal hernia repair include the total extraperitoneal (TEP) inguinal hernia repair and the transabdominal preperitoneal procedure (TAPP). Both have comparable outcomes and the current guidelines recommend that the choice of the technique should be based on the surgeon’s skills, education and experience. The female population suffering from a hernia, as well as those with a bilateral hernia, benefit from the laparoscopic approach.
For a unilateral first time occurrence, both Lichtenstein as well as the laparoscopic procedures are recommended. A recurrent hernia repair is preferably approached via the opposite route of the prior operation.
This Open Inguinal Hernia Repair (Lichtenstein) - Indirect Hernia course will teach you:
- Repositioning of the hernia sac
- Tension free reinforcement of the posterior wall of the inguinal canal using a mesh
Special attention is paid to the following hazards you may encounter during the Open Inguinal Hernia Repair (Lichtenstein) - Indirect Hernia:
- Ilioinguinal nerve injury
- Postoperative hemorrhage
- Genital branch of the genitofemoral nerve injury
- Iliohypogastric nerve injury
- Ductus deferens injury
- Adhesions of the spermatic cord to the internal inguinal ring
- Pubic periosteum injury
- Femoral vessels and nerve injury
- Ilioinguinal nerve entrapment
- Inadequate width of prosthetic ring
With the following tips you might perform the Open Inguinal Hernia Repair (Lichtenstein) - Indirect Hernia even better:
- Optimal cosmetic results
- Traction during subcutaneous tissue transection
- Scarpa’s fascia in older patients
- Isolation of the cremasteric vein with the spermatic cord
- Iliohypogastric nerve transection
- Lipoma of the spermatic cord
- Large hernia
- Hernia sac transection
- Sliding lipoma
- Facilitating mesh and pubic tubercle overlap
- Level of the new internal inguinal ring
- Measuring the width of the new deep inguinal ring
After studying this Open Inguinal Hernia Repair (Lichtenstein) - Indirect Hernia course you are familiar with the most common complications:
- Recurrence
- Seroma and surgical site infection
- Chronic postoperative ilioinguinal pain |
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Education |
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surgery | inguinal hernia | hernia | nucleus medical media | live surgery | pediatric surgery | open inguinal hernia repair (Lichtenstein) - indirect hernia | open inguinal hernia repair | indirect hernia | Repositioning of the hernia sac | External oblique aponeurosis exposure | Spermatic cord isolation | Spermatic cord mobilization | Hernia sac reduction | Mesh placement | Wound closure | Ilioinguinal nerve injury | Postoperative hemorrhage | Genital branch of the genitofemoral nerve injury |
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