Surg Clin North Am. Dec;78(6) Inguinal hernia repair. The Nyhus posterior preperitoneal operation. Patiño JF(1), García-Herreros LG, Zundel N. A hernia is an outpouching of the parietal peritoneum through a preformed or secondarily established hiatus. If the hernia Table Ib. Nyhus hernia classification. Adapted with permission from Nyhus LM, Klein MS, Rogers FB. Inguinal hernia. Curr Probl Surg ;
|Country:||Papua New Guinea|
|Published (Last):||6 October 2012|
|PDF File Size:||18.76 Mb|
|ePub File Size:||11.44 Mb|
|Price:||Free* [*Free Regsitration Required]|
Reprints are not available from nyjus authors. This persistence does not imply the presence of a hernia, but means simply a potential for hernia formation.
The figures are well crafted, and the color plates are excellent.
Nyhus and Condon’s Hernia, 5th Edition
Obturator Hernia Obturator hernias are internal herniations through the obturator foramen, bordered by the obturator vessels and nerve.
The group 3 hernia repairs Lichtenstein and Rutkow techniques use the same initial approach as open anterior repair. Today the surgeon has a great variety of different biomaterials to choose of Table III. Any recurrent hernia, either inguinal, epigastric, umbilical, or at any other location, must be understood as an incisional hernia. Patients undergoing peritoneal dialysis also have a high incidence of these hernias.
Another section is devoted exclusively to the options of hernia repair. The techniques in the open anterior repair group differ somewhat in their approach to reconstruction, but they all use permanent sutures to approximate the surrounding fascia and repair the floor of the inguinal canal.
This repair reconstructs the inguinal canal without using a mesh prosthesis. The hernial sac can then migrate down along the femoral vessels into the anterior thigh.
Dissection then continues behind and deep to the entire inguinal region. Each procedures has its own advantages and complications. In recent studies, a defect in collagen metabolism could be proven as well, indicating the key role of the development of a mechanically strong scar tissue. In case of uncertain clinical findings, sonography is the best means for confirming the hernial opening and content. The advantages of local anesthesia include the very short recovery time and the ability to test the repair intraoperatively with a Valsalva maneuver.
Get immediate access, anytime, anywhere. It was first described by Roland Arnaud de Ronsil in In addition, they require general anesthesia, and the long-term hernia recurrence rate with these procedures is unknown. However, caution is advised, since a recent study 27 of open herniorrhaphy showed that return to work was most often determined by the patient’s type of insurance coverage rather than the type of procedure used to repair the hernia. Depending on the size of the outpouching, we speak of complete total or incomplete partial hernias.
Ultrasound examination of the inguinal region with the patient in the supine and upright positions and with the Valsalva maneuver has been reported to have a diagnostic sensitivity and specificity of greater than 90 percent.
Besides the routine use of general anesthesia and procedure-related increased costs, the cumulating long-term mesh complications as shrinkage, erosion of neighboring structures such as blood vessels, spermatic cord, or bladder, adhesion- and fistula-formation, and a possible reduction of the abdominal wall mobility, make final evaluation of these surgical procedures impossible for the time being.
PMC ] [ PubMed: Journal List Ann Surg v. This breakdown may occur because of incomplete dissection, poor tissue quality longstanding large hernias or the patient’s too-rapid return to daily activities.
Inguinal hernia repair. The Nyhus posterior preperitoneal operation.
This is a corrected version of the article that appeared in print. The hernial orifice is in the muscles of the lumbar area.
Posterior repair iliopubic tract repair and Nyhus technique is performed by dividing hernka layers of the abdominal wall superior to the internal ring and nyhhus the properitoneal space. Several studies 89 have found that, with proper preoperative preparation, more than 90 percent of groin hernias can be repaired with patients receiving only a local anesthetic. Average of 24 months range: Since that time, three laparoscopic procedures have been established: Each is also featured for pros and cons i.
Any factor that impairs normal wound healing may contribute to the development of incisional hernia. Indication for surgical repair are occurrence of complaints and complications or a persistence of the hernia beyond the age of 2 years. Usually, the hernia sac content is preperitoneal fatty tissue. Clear Turn Off Turn On.
Nyhus and Condon’s Hernia
Consequently, the bowel or vascular structures may be injured during the procedure Figure 8. The femoral vein also runs just deep to the inguinal floor laterally. The transversalis fascia is then opened, facilitating inspection of the inguinal canal, the indirect space and the direct space. The use of fascia grafts to close large hernial orifices and recurrent hernias dates back to HalstedKirschnerRehnand Koontz It was only in the middle of the twentieth century that Bassini’s concept was improved by Shouldice and McVay and Ansonshowing the importance of the fascia transversalis.
Umbilical hernias in adults are indirect herniations through the umbilical canal, and there have a high tendency to incarce-rate and strangulate and do not resolve spontaneously. This approach is well suited for outpatient herniorrhaphy performed with the patient receiving local anesthesia. Results of a multicenter trial. Address correspondence to Brett C.
The first series of laparoscopic herniorrhaphies were published by Schultz in Umbilical Hernia The umbilicus is a natural hernial opening in the abdominal wall. To what extent a hernia represents a disease entity rarely depends on the fact of the hernia itself, but rather on the fate of hernial contents. Perineal hernias are primary or secondary herniations of the pelvic floor that appear para- or retrorectally between the levator ani and coccygeal muscles.
Again, all are very well written and loaded with information regarding repair and management.