Skip to Main Content

++

  • Recent literature suggests that patients who are asymptomatic or "minimally symptomatic" may be managed without surgical intervention.
  • All symptomatic inguinal hernias (pain, neurologic symptoms) should be repaired unless a specific contraindication exists.
  • Inguinal hernias that are incarcerated and are reduced in a timely fashion should be repaired on an urgent basis.
  • Hernias that are unable to be reduced should be treated as a surgical emergency and repaired expeditiously.

++

  • There are no absolute contraindications.
  • In the event the patient cannot undergo general or spinal anesthetic, the repair can be performed under local anesthetic with sedation.

++

Potential Risks

++

  • Bleeding.
  • Infection (potentially requiring reoperation to remove infected mesh).
  • Damage to nerves resulting in loss of inner thigh skin sensation.
  • Damage to the vas deferens or testicular vessels potentially leading to decreased fertility.
  • Recurrence.
  • Neuralgia.

++

  • Nothing by mouth for 6 hours before surgery.
  • Blood thinners should be discontinued with adequate time for normalization of coagulation.
  • Foley catheter insertion is required for laparoscopic procedures only.

++

  • The patient should be supine.

++

Open Inguinal Hernia Repair

++

  • The operation may be performed under spinal, local, or general anesthesia.
  • Figure 40–1: Inguinal hernia locations.
  • Figure 40–2A: Landmarks for skin incision are the anterior superior iliac spine and pubic tubercle.
    • The incision should be superior to the inguinal ligament and, if possible, hidden in a natural skin crease.
  • Figure 40–2B: The subcutaneous tissue should be divided until the external oblique fascia is encountered.
    • A regional local anesthetic block may be placed at this time (10 mL of 0.5% bupivacaine infiltrated subfascially into the deep muscular layers and retroperitoneum along the iliac fossa region 2 cm medial and cephalad to the anterior superior iliac spine).
    • The external oblique fascia is then divided sharply to expose the underlying cord and hernia.
  • Figure 40–3: The hernia sac is dissected free from the associated cord structures.
    • Care should be taken to identify the ilioinguinal nerve and retract it away from the area of dissection to avoid injury.
    • Indirect hernias originate from the internal ring and are located anteromedial to the cord structures.
    • Direct hernias come directly through the floor and push the cord structure superficially.
    • Sliding hernias arise lateral to the cord.
  • Figure 40–4: The hernia sac is opened and the contents are visualized to ensure that no incarcerated bowel is present. The sac is then amputated and ligated with a suture ligature.
    • If the internal ring is widely dilated, sutures may be placed to tighten it medially, laterally, or in both directions.
    • A large direct hernia may be navigated by sutures in the inguinal floor.
  • Figure 40–5: A piece of polypropylene mesh is then cut to a keyhole shape and sewn medially to the pubic tubercle with a 2-cm overlap on the tubercle, inferiorly to the shelving edge of the inguinal ligament, and superiorly to the internal oblique fascia.
    • The internal ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.