hernia Flashcards
1
Q
describe repair of inguinal hernia with mesh
A
- incision over inguinal canal
- open external oblique fascia
- identify and preserve ilioinguinal nerve
- isolate spermatic cord with penrose. preserve genitofemoral nerve.
- identify hernia sac and separate it from cord structures
- for direct hernia, sac is inverted into fascial defect
- for indirect hernia, high ligation of sac and excision or inverted into internal inguinal ring
- place onlay mesh with keyhole for cord
- suture mesh
- medially at pubic tubercle
- laterally into muscle beyond external ring
- superiorly to conjoint tendon
- inferiorly to shelving edge of inguinal ligament
- close external oblique fascia
2
Q
describe McVay repair of inguinal hernia
A
- incision b/w ASIS and pubic tubercle
- ligate any superficial epigastric veins
- expose external oblique aponeurosis
- incision of external oblique to external ring medially
- preserve ilioinguinal n.
- dissect out spermatic cord, penrose
- separate cremaster muscle and dissect hernia sac
- suture conjoint tendon to coopers ligament, then at level of femoral vein, place transition suture and continue suture from conjoint tendon to inguinal ligament
- close external oblique
3
Q
femoral hernia repair
A
- incision b/w ASIS and pubic tubercle
- I.D. hernia sac inferior to inguinal ligament
- dissect hernia, reduce it if possible
- place rolled mesh into femoral ring
- fixate mesh superiorly to inguinal ligament and inferiorly to pectineal ligament
- ** watch for femoral vein**
4
Q
describe Nissen fundoplication
A
- modified lithotomy, stand between legs
- place 5, 5-10mm ports in upper abdomen
- place liver retractor, retract liver
- mobilize stomach (divide gastrocolic and gastrosplenic ligaments and mobilize fundus
- gastrohepatic omentum is divided and phrenoesophageal membrane
- identify anterior vagus n.
- dissect esophagus, penrose
- place bougie (52-54 Fr.)
- close crura with 0 or 2-0 ethibond
- fundus wrap around
