HERNIORAPHY elvie

8/3/2019 HERNIORAPHY elvie

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The surgical repair of a hernia.Herniorrhaphy may be done underlocal or general anesthesia using a

conventional incision or alaparoscope. The term "herniorrhaphy" comes from

hernio-, referring to a hernia + the

Greek rhaphe, a seam = putting aseam (or suture) in a hernia.


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Repair of a musculofascial

defect, through whichvarious organs or tissues

may present.


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1.Inguinal (Direct, Indirect) and Femoral

The musulofascial defect in the groin, the

herniated tissues presenting through posterior

inguinal wall medial to the deep inferiorepigastric vessels (direct); or through the deep

inguinal ring and inguinal canal, emerging at

the superficial inguinal ring (indirect); or

through the femoral canal (femoral).


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2. Umbilical

Within the umbilicus (or both the umbilicus:

paraumbilical) most often seen in children or

obese adults.

3. Epigastric

Defect in the abdominal wall between the

xiphoid process and the umbilicus through

which fat protrudes.


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4. Incisonal (ventral)

A defect within the scar of a surgical incison

(abdominal).

Hernias are either reducible or irreducible, thatis, incarcerated. The contents of an incarcerated

hernia may become strangulated,

compromising the viability of trapped tissueand necessitating their resection in addition to

herniorrhaphy.


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Several techniques are employed for each of

these h over the site of the defect. Blunt andsharp dissection are employed to expose the

hernia sac and surrounding musculofascial

defect. With incisional hernias, the peritonealcavity may be entered. The hernia sac may be

allowed to retract, sutured over (imbricated) or

excised. The musculofascial defect may be

closed employing a wide variety of techniquesand sutured materials, and occasionally a mesh

prosthesis.


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The patient is supine with thearm on the affected side extend

on an armboard. Apply

electrosurgical dispersive pad. If

local anesthesia is employed, see

circulator responsibilities.


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1.Inguinal & Femoral

Begin at the incision extending from umbilicus

to midthigh (including a wide margin beyond

the midline), and down to the table on the

sides; external genitalia are prepped last.

2.Umbilical

Begin at the incision extending fro the nipples toupper thighs, and down to the table at the

sides.


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3.Epigastric

Begin at the incision, extending from the

clavicles to the upper thighs, and down to the

table at the sides.

4.Incisional

Begin at the side of previous incision widely

enough to allow for extension of the incision.


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Folded towels and a fenestrated sheet.

Basic/Minor procedures tray

Self-retaining retractor

Electrosurgical unit


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Basin set

Blades (2) no. 10, (1) no. 15

Needle magnet or counter

Penrose drain (small, for retraction, optional)

Dissectors

Electrosurgical pencil

Skin closure strips (optional)


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The small penrose drain (used to isolate the

spermatic cord) is moistened in aaline and

passed on a Pean clamp.

Synthetic mesh such as Mersilene or Marlex isoften used to repair recurrent hernias or large

ventral defects.


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Repair of an inginofemoral musculofascialdefect employing laparoscopic technique.

Laparoscopic groin herniorrhaphy is among the

most controversial laparoscopic procedures

being performed. The present techniques of

traditional hernia repair are proven techniques,

performed without


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Violation of the abdominal cavity,

often under local anesthesia. The

advantages of laparoscopic hernia

repair are purported to be marked

reduction of pain and rapid returnto normal activity. The

disadvantages are the requirement

for general anesthesia and a lack of

long-term follow-up data.


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Following the establishment of a

pneumoperitoneum, a 10 to 11 mm laparoscopeis inserted through the umbilical port. The

patient is placed in the Trendelenburg position,

and the abdomen is inspected. A second and

third 10 to 11 mm port are created lateral to the

rectus sheath at the level of the umbilicus on the

side of the defect. Both inguinal rings are

examined for hernias.


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the hernia sac, if present, is retracted out of

the inguinal canal, and a segment is

excised. Peritoneal flaps are developed by

blunt dissection. Care is taken to avoid

injury to the spermatic vessels and vas

deference in male. A piece of mesh is

fashioned to cover the hernial defect and

the surrounding rim of the abdominal wall.

The mesh is then inserted via a port and isplaced over the hernia defect.


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endoscopic staples are employed to staple the

mesh to the abdominal wall. Care is again

taken to avoid injury to the spermatic vessels,

vas deferens, and epigastric and illiac vessela as

indicated. The pnuemopereitunium is relaxed.

The peritonial flaps are then stapled together tocover the mesh and as an attempt to prevent

adhesions to the bowel. Contralateral repair has

been advocated by some authorities despite

absence of a frank hernia.


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The patient is supine; both arms may be padded

and tucked in patients side. Apply electrosurgical

dispersive pad. A foley catheter is not routinely

inserted.

Folded towels and a laparoscopy sheet


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Electrosurgical unit with foot control

Suction

Fiberoptic light source

Video monitors

VCR (optional)

Insufflator

Pressure bag (optional)


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Verres needle

Trocars 5mm, 10 mm, 12 mm

Reducers

Dissecrtors

Graspers

Scissors

Stapler

Clip applers

Suction


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Hydraulic dissector

Telescopes

Camera and cable

Foam padding for elbow, blanket for under

knees

Fog reducing agent

Blades no. 10 (1), no. 15 (1) or no. 11 (1)

Suction tubing

:


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After the patient is in the room, position

monitors.

The circulators checks CO2 level

Following draping, the scrub person will pass off

camera cable, light cord, suction tubing, andelectrocautery cord.

The circulator adjusts the insufflator, and then

high flow according to the surgeons directions. Connect and turn on light source and white

balance camera.


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The circulator will turn on the VCR (to record) if

requested.

Recheck position of monitors so they can beeasily viewed.

The circulator connect remaining items;

irrigation tubing, suction tubing, and

electrosurgical cord.

Keep lens clean as necessary.

The circulator positions the electrosurgical unit.

HERNIORAPHY elvie

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