The Bassini technique for inguinal hernia repair involves suturing the transversalis fascia and the conjoined tendon to the inguinal ligament behind the spermatic cord with monofilament nonabsorbable suture. Diagnosis and treatment of genitofemoral and ilioinguinal neuralgia. A total of 286 short chapters organized into 24 Sections provide operative dictation templates for all of the common and the vast majority of the uncommon and even rare operations performed by general and vascular surgeons. Deliberate sectioning of the nerves intraoperatively to prevent chronic groin pain has been described but is still controversial. Finally, patients should be monitored for recurrence, which may arise as a consequence of inadequate repair, wound infection, or chronic straining (eg, from coughing, constipation, or urination). [25]. With the mesh kept lax, its upper edge is then fixed to the rectus sheath and the internal oblique aponeurosis with two or three interrupted nonabsorbable sutures (see the first image below). [Medline]. [Medline].

Weyhe D, Belyaev O, Müller C, Meurer K, Bauer KH, Papapostolou G, et al. 2002 Dec. 6(4):171-4. Tails are then passed underneath external oblique aponeurosis to give overlap of about 5 cm beyond internal ring. A 7.5 × 15 cm piece of polypropylene mesh is commonly used for a Lichtenstein hernioplasty. 240(1):187-92. Iliohypogastric nerve injury. Open inguinal hernia repair. An alternative anterior tension free preperitoneal patch technique by help of the endoscope for femoral hernia repair, International Journal of Clinical Practice, https://doi.org/10.1111/j.1742-1241.2005.00551.x. [54]. Sanabria A, Dominguez LC, Valdivieso E, Gomez G. Prophylactic antibiotics for mesh inguinal hernioplasty: a meta-analysis. JAMA.

Recurrence may be more frequent in the presence of comorbid conditions (eg, chronic obstructive pulmonary disease) or obesity or with the use of steroids. A spigelian hernia is managed in a similar manner.

Nilsson H, Stylianidis G, Haapamaki M, Nilsson E, Nordin P. Mortality after groin hernia surgery. 2006 Aug. 244(2):212-9. [Medline]. Improving outcomes in hernia repair by the use of light meshes--a comparison of different implant constructions based on a critical appraisal of the literature.

Complications may develop intraoperatively or postoperatively.

A small or medium-sized hernia sac may be isolated and inverted into the preperitoneal space without suture ligation. Cord structures and hernia sac looped along with ilioinguinal and genitofemoral nerves. Chap 205. Sanchez-Manuel FJ, Lozano-García J, Seco-Gil JL. If a sac is seen entering the femoral ring, it is reduced and dealt with by inverting or ligating the neck of the sac. Another cause of significant postherniorrhaphy pain is the placement of a stitch into the periosteum at the pubic tubercle for fixation of the mesh medially. The ilioinguinal nerve, because it lies in the inguinal canal along with the spermatic cord, may be injured during dissection of the cord. Hemostasis is ensured in the inguinal canal, which is then closed by suturing the two flaps of the external oblique aponeurosis (see the images below), with care taken not to injure the underlying ilioinguinal nerve. Prospective evaluation of 6895 groin hernia repairs in women. Chronic inguinodynia is defined as pain persisting more than 3 months post herniorrhaphy, after the process of wound healing is complete. Open inguinal hernia repair. Although the risk is very low, routine exploration of the femoral canal is advised in the absence of an inguinal hernia and in women. [Medline]. Ann Surg. 2000 Dec. 87 (12):1722-6. Open inguinal hernia repair. The conjoined tendon is then sutured to the inguinal ligament, again in two overlapping layers.

2004 Mar. Dr Kapoor would like to express his gratitude to his teachers and trainers, (the late) Prof Atm Prakash and Prof L K Sharma, who taught him the techniques and principles of hernia repair when he was a surgical trainee at the All India Institute of Medical Sciences, New Delhi, India, in the early 1980s. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice.

The plug-and-patch repair adds a polypropylene plug shaped as a cone, which can be deployed into the internal ring after reduction of an indirect sac.

[Medline]. 1: 294-307. 1981 Nov. 142(5):628. Surgical site infection after groin hernia repair. The same suture is then used as a continuous suture to fix the lower edge of the mesh to the free lower border of inguinal ligament up to a point just lateral to the internal ring (see the images below). A thorough clinical evaluation, a high degree of suspicion, and diligent follow-up are advised to keep track of recurrences.

Upper tail is crossed over lower tail around spermatic cord, thus creating internal ring. Wijsmuller AR, Lange JF, Kleinrensink GJ, van Geldere D, Simons MP, Huygen FJ, et al. In an audit of Lichtenstein hernioplasty performed with local anesthesia by surgical residents, the recurrence rate was 2.1% over a 10-year follow-up period. 2002 Sep. 184(3):259-60. 1989 Sep-Oct. 13(5):586-91. The indirect hernia sac lies anterolateral to the cord structures and is visualized by dividing the cremaster muscle longitudinally (see the image below).

They should not be dissected free from their natural bed; doing so can lead to perineural fibrosis and chronic pain postoperatively. [Medline]. This is a preview of subscription content, © Springer Science+Business Media, LLC 2012, Operative Dictations in General and Vascular Surgery, https://doi.org/10.1007/978-1-4614-0451-4_97.

Procedures, 2002 Br J Surg. CD003769. 247 (3):428-33. Lichtenstein IL, Shulman AG, Amid PK, Montllor MM.

Spermatic cord layers are closed with fine sutures, with care taken to avoid damaging the cord contents. 18 (2):165-76. Awad SS, Fagan SP. 2011 Apr 14.

Open inguinal hernia repair.

The authors and editors of Medscape Reference thank Karen Medin for her illustrations. Open inguinal hernia repair. Open inguinal hernia repair. [Medline].

Designed as a portable Ann Surg. 2002. Long-term follow-up of patients with a painless inguinal hernia from a randomized clinical trial.

[Medline]. Philadelphia: Wolters Kluwer; 2012. Next, a slit is made in the lateral end of the mesh to create a narrower lower tail (the lower one third) and a wider upper tail (the upper two thirds). To compensate for future shrinkage, the mesh should be wide enough to extend 3-4 cm beyond the boundary of the inguinal triangle. Am J Surg. All of these structures may then be encircled in a tape for ease of handling. [Medline]. There was no recurrence at the time of writing. 362(9387):853-8. Fixation of lower edge of mesh. 2004 Aug. 8 (3):186-9. [Medline]. [Medline].

Procedures, encoded search term (Open Inguinal Hernia Repair) and Open Inguinal Hernia Repair, Fetal Surgery for Congenital Diaphragmatic Hernia, Banded Versus Nonbanded Sleeve Gastrectomy, Sex, Age Among Predictors of Ongoing Pain After Laparoscopic Inguinal-Hernia Repair, First Report of CSF Leak After COVID-19 Nasal Swab Testing, Colonoscopy Prep: Overturning the Clear-Liquid Diet, Ulcerative Colitis: Adopting the AGA's Guidelines, Fecal Transplant Shows Promise in Reducing Alcohol Craving, Iron Deficiency Anemia Clinical Practice Guidelines (AGA, 2020).

External oblique aponeurosis sutured with 2-0 polypropylene. The patient is asked to cough, and the groin region is examined for the presence of an indirect hernia, a direct hernia, a femoral hernia, a combined hernia, or a spigelian hernia. Chronic pain after mesh hernioplasty also results from neuroma formation after accidental division of the nerves. J Pediatr Surg.

The neck of a large hernia sac is transected at the midpoint of the inguinal canal (see the first image below), and the proximal part is suture-ligated. Surgeons must know and understand these repairs so that they can be carried out when they are appropriate. In addition, injury to the urinary bladder, cecum, or sigmoid colon may occur during transfixion of the hernial sac in a sliding indirect inguinal hernia (where these viscera are not contained in the hernial sac but form a part of the wall of the sac). Available at https://www.anesthesiologynews.com/Online-First/Article/03-20/New-Implant-Combined-with-Bupivacaine-Hydrochloride-Approved-for-Pain-After-Hernia-Repair/59475.

New York: McGraw-Hill; 2015. The upper tail is then passed underneath the cord in such a way as to position the mesh posterior to the cord in the inguinal canal (see the image below), and the spermatic cord is placed between the two tails of the mesh.

If any of the nerves is injured or of doubtful integrity, it can be resected and its proximal end ligated and buried within the fibers of the internal oblique muscle to keep the stump of the nerve away from scarring. No more than four or five passes are required.

[Medline]. [Medline]. Cochrane Database Syst Rev.

Gianetta E, Cuneo S, Vitale B, Camerini G, Marini P, Stella M. Anterior tension-free repair of recurrent inguinal hernia under local anesthesia: a 7-year experience in a teaching hospital.

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