Surg Clin North Am. Dec;78(6) Inguinal hernia repair. The Nyhus posterior preperitoneal operation. Patiño JF(1), García-Herreros LG, Zundel N. The Nyhus Posterior Preperitoneal Operation The repair of inguinofemoral hernias constitutes the most widely performed general surgical procedure. Adapted with permission from Nyhus LM, Klein MS, Rogers FB. Inguinal hernia. Curr Probl Surg ;

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The development of this type of hernia requires a potential hernia sac, which is provided by the processus vaginalis. Create a personal account to register for email alerts with links to free full-text articles.

The tables are useable and the references are relevant. In some series, the laparoscopic approach has been 40 percent more costly than other approaches.

Inguinal hernia repair. The Nyhus posterior preperitoneal operation.

The TAPP approach involves placing laparoscopic trocars in the abdominal cavity and approaching the inguinal region from the inside. Excellent results have been reported for the posterior techniques, but problems related to suture tension remain.

General anesthesia provides the most comfort, but it has the highest risk. Several studies have demonstrated that this approach is safe and involves only minimal use of pain medication.

Sam Jackson Park Rd. The iliohypogastric nerve passes superior to the internal inguinal ring and provides sensory innervation to the skin superior to the pubis.

Recurrent hernias repaired with classical herniorrhaphy not utilizing mesh have a reported recurrence rate of approximately 23 percent at three years. Ann R Coll Surg Engl.


The approach is best determined by local expertise. Each is also featured for pros and cons i.

Surgical Options in the Management of Groin Hernias – – American Family Physician

Dissection then continues behind and deep to the entire inguinal region. These chapters are a superb source for resident review prior to any hernia case.

Systemic comorbidity, such as obesity, steroid use and chronic obstructive pulmonary disease, influence wound healing and hrnias affect the recurrence rate. The advantages of local anesthesia include the very short recovery time and the ability to test the repair intraoperatively with a Valsalva maneuver.

Nyhus and Condon’s Hernia

Results of a multicenter trial. 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. In the TEP approach, an inflatable balloon is placed in the extraperitoneal space of the inguinal region. Most hernias can be diagnosed based on the history and clinical examination, but ultrasonography may be useful in differentiating a hernia from other causes of groin swelling.

Mechanisms of hernia recurrence after preperitoneal mesh repair. Three major types of open repair are currently used, and laparoscopic techniques are also employed. Surg Clin North Am. In the extremely rare patient with inguinal pain but no physical or sonographic evidence of inguinal herniation, computed tomographic scanning can be used to evaluate the pelvis for the presence of an obturator hernia.

The hernia sac passes directly through Hesselbach’s triangle and may disrupt the floor of the inguinal canal. Inguinal hernias continue to be a source of morbidity and significant health care expenditure.


This is the nerve most commonly injured during open herniorrhaphy. However, chronic neuralgia can develop.

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A broad portion of mesh is stapled to span both hernia defects. Another section is devoted exclusively to the options of hernia repair. This is a corrected version of the article that appeared in print. Sign in to customize your interests Sign in to your personal account. However, this corrective approach provides relief in less than 60 percent of patients. Surgical repair is usually advised because of the danger of incarceration and strangulation, particularly hdrnias femoral hernias.

Average of 12 months range: Sign in to save your search Sign in to your personal account. The major nerves in the inguinal region are the ilioinguinal, iliohypogastric and genitofemoral nerves. The anatomic region known as Hesselbach’s triangle is defined laterally by the inferior epigastric artery, medially by the lateral border of the rectus muscle and inferiorly by the inguinal ligament Figure 1.

Patients with ascites generally should not undergo elective herniorrhaphy until their ascites is controlled. Inflation of the balloon creates a working space. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.