Inguinal Anatomy/Technique Flashcards
What are the two types of Inguinal Hernias?
Direct and Indirect
Two reasons for weakness’s in the groin
Internal oblique and transverse abdominal don’t cover down to the inguinal ligament -direct hernia
Muscles do not tighten around spermatic cord- indirect hernia
Indirect sac is made out of the
peritoneum
Which tend to be larger? Indirect or Direct hernias?
Direct
Location of Direct Hernia?
Medial to epigastric
Location of Indirect hernia?
Lateral to epigastric
Location of femoral hernia?
Just below inguinal ligament
Lichtenstein Repair Technique
anterior approach to anterior repair
Plug Repair Technique
anterior approach to anterior or posterior repair
MK Technique
anterior approach and posterior repair
3 Different Types of Open Repairs
Lichtenstein, Plug Repair and MK Repair
2 Types of Laproscopic Repairs
TAPP and TEP
TAPP stands for
Transabdominal prepirtoneal apprach
TEP stands for
Totally Extra Peritoneal Approach
TAPP Approach (steps)
approached via abdominal cavity peritoneum is incised hernia sac is dissected and reduced mesh is placed to cover the inguinal area peritoneum is re-approximated gas removed from the abdomen
TEP Approach (steps)
Balloon dissector used to separate peritoneum from the muscles and fascia of the abdominal wall
Hernia sac is opened and may be severed
Mesh is placed to cover defect area
CO2 removed from abdomen
Triangle of Pain
Nerves - area of femoral branch
Triangle of Doom
Blood supply (iliac vessels)
Advantages of LAP
Minimally invasive
Minimal pain
quick recovery
good visibility for detecting other defects
Disadvantages of LAP
general anesthesia
high costs
severity of complications high
Classic Technique for Indirect Hernia
Grasp the whole plug and insert into defect
Suture outer cone to margins of defect
Modified Technique Indirect Hernia
Grasp inner petals and place deep into defect allowing outer cone of plug to open in perperitoneal space
Suture inner petals to margins of defect
What is the importance of fixating the peritoneum in a TAPP procedure
protects the bowel from growing into the mesh
