Incarcerated hernia A hernia that can not be reduced, or pushed back into place inside the intestinal wall. Mentioned in: Hernia Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

incarcerated hernia Etymology: L, in + carcerare, to imprison, hernia, rupture a loop of bowel with ends occluded so that solids cannot pass. The herniated bowel will not return to its normal position without manipulation or surgery. It is essential to correct the condition before the bowel becomes strangulated. Also called irreducible hernia. Mosby's Medical Dictionary, 8th edition. 2009, Elsevier. How to perform an Open Inguinal Hernia Mesh Repair: (Hernioplasty or Herniorrhaphy) in a Male. 1. Prior to surgery ensure you have taken an adequate history and examination. Confirm a hernia is present and you have identified the correct side. Is it reducible? (Important if to be done under LA as not really possible if not reducable) Does it extend into the scrotum. Is there an associated hydrocoele etc. 2. Ensure patient is correctly consented and marked. Following administration of general anaesthetic or a local block + infiltration, the patient may need to be shaved to expose the skin. 3. The region should be prepared with antisteptic soloution. The patient should be draped in order to expose the anterior superior iliac spine to the midline, and from below the pubic symphysis / base of penis in males, to below the umbilicus. And sterile towel can be placed over the genitals to protect from prep solution and adhesion from drapes. 4. The landmarks of the anterior superior iliac spine (ASIS) to the pubic tubercle should be palpated. This marks the line of the inguinal ligament. An oblique incision parallel to this line should be made above - approximately 3-4 cm. 5. The skin is divided using a sharp blade. Diathermy can then be used to dissect the underlying superfical fatty layer (Campers fascia). A self retaining retractor can be inserted. The retraction helps separates the structures and aids finding the anatomical plane. The retractor is a dynamic tool, and should regularly be adjusted to help the surgeon. 6. The superficial inferior epigastric vein lies relatively superficially and should be ligated

and divided if encountered. 7. Dissection using a combination of tension from the retractor, elevator and use of diathermy allows the tissues to be divided through the fatty layer, then the deeper fibrous layer (Scarpas fascia) down onto the external oblique tendon. 8. Once the fibres of the external oblique have been identified, the dissection should be continued in the direction towards the inguinal ligament, using a combination of blunt dissection/ dry gauze. Once the edge of the inguinal ligament has been visualized it confirms the correct anatomical landmarks. 9. The next step is to incise external oblique, above the superifical inguinal ring. A blade is used to make a small incision running in parallel with the fibres of the tendon above the ring. Dissecting scissors can initially be passed under the tendon closed to create a safe passage, before being used to cut and split the external oblique tendon laterally to beyond the length of the incision and medially to open the superficial ring. 10. A clip should be attached to the external oblique tendon on each side. The hernia sack or cord structures may adhere to the inferior aspect of the divided tendon and should be carefully dissected away. Blunt dissection with a finger or dry gauze can help. Enough space should be created at this stage to facilitated placement of the mesh later. 11. The cord and hernia should be dissected to expose the inguinal ligament edge inferiorly and the pubic tubercle medially. A finger should be able to pass freely around the spermatic cord indicating it is also free posteriorly. A small window in the fascia may need to be made using dissection scissors if this is not possible using blunt dissection techniques. 12. Next the important cord structures of the vas deferens, testicular artery and veins, lymph vessels, autonomic nerves, cremasteric artery, artery of the vas and the genital branch of the genito-femoral nerve , need to be identified, separated from the hernial sac and preserved. 13. Non-traumatic forceps (eg Lanes) may be used to safely retract and separate the cord structures when identified. 14. The hernia sac should now be separated from the spermatic cord structures. Tissue adherent to the hernia sac should be dissected and divided away from the sac, in the direction of the inguinal canal. (The path of descent). A combination of blunt and sharp dissection may need to be used. 15. Once the hernial sac is identified, it can be dissected to confirm its contents. Two clips can be used to pick up the white peritoneal layer. The sac contents can be carefully opened, remembering that the hernia may contain bowel! The hernia may comprise of retroperitoneal fat, bowel, bladder, omentum or any combination. Ensure the contents is fully reducible inside the abdominal cavity, through the deep inguinal ring (indirect hernia) or the defect on the conjoint tendon (direct). 16. Following reduction of the hernia sac, the defect in the conjoint tendon may be

plicated. Care should be taken to ensure the hernia sac does not protrude prior to the completion of this posterior wall repair. An assistant can be useful to prevent this using the blunt end of forceps to retract the hernia sac. 17. Following successful reduction of the hernia +/- plication - the mesh is ready to be inserted. There are a variety of synthetic meshes available, some with self retaining properties. 18. In principle the mesh should be correctly sized for the patient. It should be trimmed and shaped to fit the space created at the initial stages of the operation under the external oblique tendon. The inferior edge of the mesh should be split to match the distance the deep ring lies from the inside edge of the inguinal ligament. This allows an inferior tail of the mesh to be passed under the spermatic cord using a clip from medial to lateral, and lie inline and parallel to the inguinal ligament. 19. The edge of the mesh inferior tail can then be secured to the edge of the inguinal ligament. The apex of the mesh should lie over the pubic tubercle. It should be secured with a suture to the underlying pubic tubercle using a single suture. The mesh should be Tension Free and cover the defect in the posterior wall. 20. Ensure the mesh gives adequate medial coverage at the tubercle, as recurrence can often happen here. Further sutures can be used to secure the top of the mesh to fibres of the underlying conjoint tendon. 21. The superior tail of the mesh should overlap the inferior tail, around the spermatic cord at the deep inguinal ring. Enough space should be left for the spermatic cord to pass through, but not loose enough that an indirect hernia might recur. 22. The superior and inferior tails of the mesh should be secured to each other as well as the inferior edge of the inguinal canal. Once the mesh is secure, depending on type used, the external oblique can be closed. 23. Using an monofilament suture, a continuous suture can be used to close the external oblique layer. Use your assistant to ensure that the underlying mesh is not picked up in closing this layer. An inverted retractor on blunt end of forceps can be used. 24. Interrupted or continuous sutures using an absorbable suture can be used to close the deep fascial layer (Scapas fascia). 25. The skin can then be closed using a subcuticular absorbable suture or interrupted sutures or staples. 26. A suitable dressing should be applied. Post op instructions: The patient should be advised on wound care in the initial period, i.e. don't soak in a bath 2/52; avoid public swimming baths for 2/52 and keep wound dry.

Advice should be given with regard to driving. Generally one week is advised, but also advise patient to attempt emergency stop whilst stationary before driving and probably wise to consult insurance company. Advise to avoid strenuous activity and heavy lifting for up to 6 weeks, give the appropriate "doctors note".

April 14, 2005 --; Herniorrhaphy with polypropylene mesh may cause inguinal vasal obstruction (IVO) with resultant infertility, according to the results of a case series published in the April issue of the Annals of Surgery. "An estimated 80% of inguinal hernia operations involve placement of a knitted polypropylene mesh to form a 'tension-free' herniorrhaphy," write David Shin, MD, from Baylor College of Medicine in Houston, Texas, and colleagues. "The prosthetic mesh induces a chronic foreign-body fibroblastic response creating scar tissue that imparts strength to the floor and leads to fewer recurrences. However, little is known about the long-term effects of the polypropylene mesh on the vas deferens, especially with regard to fertility." Eight U.S. institutions reported a total of 14 cases of azoospermia caused by inguinal vasal obstruction from previous polypropylene mesh herniorrhaphy. Mean patient age was 35.5 years; average duration of infertility was 1.8 years; and mean time between urologic evaluation and herniorrhaphy was 6.3 years. Types of inguinal hernia repair previously performed were open repair in 10 men, laparoscopic in two, or both in two men. Obstruction was bilateral in nine patients, and it was unilateral in five patients with contralateral testicular atrophy or epididymal obstruction. In all men, surgical exploration revealed a dense fibroblastic response encompassing the polypropylene mesh with either trapped or obliterated vas. Eight (57%) of 14 men had surgical reconstruction. "Reconstruction to restore fertility can be difficult secondary to fibrotic reaction," the authors write. "Before undergoing polypropylene mesh herniorrhaphy, men, especially of young reproductive age or with a solitary testicle, need to be carefully advised of potential obstruction and compromise to future fertility." Study limitations include review limited to cases of IVO related to polypropylene mesh herniorrhaphy, and inability to determine whether obstructive azoospermia in these cases was a direct result of effects of polypropylene mesh repair or of surgical complications, or whether use of polypropylene mesh will result in a higher or lower incidence of IVO than standard inguinal herniorrhaphy. "Reconstruction to restore fertility is extremely difficult when vasal obstruction has occurred because of significant fibrotic reaction to polypropylene mesh," the authors conclude. "Cryopreservation of sperm is highly recommended at the time of reconstruction." In an accompanying editorial, Robert J. Fitzgibbons, Jr, MD, from Creighton University in Omaha, Nebraska, wonders how surgeons can determine with certainty that polypropylene mesh causes infertility, and how best to approach possible medicolegal consequences.

"Although Shin's findings are enlightening and certainly provide an invitation for further study, I personally do not believe they are conclusive enough to demand that surgeons change their informedconsent discussion to include a specific warning about mesh," Dr. Fitzgibbons writes. "Infertility is a known complication of inguinal hernia surgery with or without mesh, and we tell our patients that. This is not just a matter of the inconvenience of prolonging the informed consent process because, as noted above, a return to the routine use of the Bassini operation or one of its nonprosthetic variants will inevitably lead to the need for more reoperative surgery for recurrence, which places the patient at the greatest risk of loss of fertility as a consequence of testicular atrophy." Ann Surg. 2005;241:553-558

Hernia Hernia From Wikipedia, the free encyclopedia

Hernia Classification and external resources

Frontal chest X-ray showing a hernia of Morgagni ICD-10 ICD-9 MedlinePlus eMedicine MeSH K40-K46 550-553 000960 emerg/251 ped/2559 D006547

A hernia is the protrusion[1] of an organ or the fascia of an organ through the wall of the cavity that normally contains it. A hiatal hernia occurs when the stomach protrudes into themediastinum through the esophageal opening in the diaphragm. By far the most common herniae develop in the abdomen, when a weakness in the abdominal wall evolves into a localized hole, or "defect", through which adipose tissue, or abdominal organs covered with peritoneum, may protrude. Another common hernia involves the spinal discs and causes sciatica. Herniae may or may not present either with pain at the site, a visible or palpable lump, or in some cases by more vague symptoms resulting from pressure on an organ which has become "stuck" in the hernia, sometimes leading to organ dysfunction. Fatty tissue usually enters a hernia first, but it may be followed by or accompanied by an organ.

Most of the time, herniae develop when pressure in the compartment of the residing organ is increased, and the boundary is weak or weakened.

Weakening of containing membranes or muscles is usually congenital (which explains part of the tendency of herniae to run in families), and increases with age (for example, degeneration of the annulus fibrosus of the intervertebral disc), but it may be on the basis of other illnesses, such as Ehlers-Danlos syndrome or Marfan syndrome, stretching of muscles during pregnancy, losing weight in obese people, etc., or because of scars from previous surgery.

Many conditions chronically increase intra-abdominal pressure, (pregnancy, ascites, COPD,dyschezia, benign prostatic hypertrophy) and hence abdominal hernias are very frequent. Increased intracranial pressure can cause parts of the brain to herniate through narrowed portions of the cranial cavity or through the foramen magnum. Increased pressure on the intervertebral discs, as produced by heavy lifting or lifting with improper technique, increases the risk of herniation. Contents [hide]

1 Signs and symptoms 2 Causes 3 Diagnosiso o o o o o o

3.1 Inguinal 3.2 Femoral 3.3 Umbilical 3.4 Incisional 3.5 Diaphragmatic 3.6 Other hernias 3.7 Characteristics

4 Treatment 5 Complications 6 References 7 External linkso

7.1 Pictures

[edit]Signs and symptoms

Symptoms may not be present in some inguinal hernias while in some other hernias, including inguinal, they are. Symptoms and signs vary depending on the type of hernia. In the case of reducible hernias, you can often see and feel a bulge in the groin or in another abdominal area. When standing, such bulge becomes more obvious. Besides the bulge, other symptoms include pain in the groin that may also include a heavy or dragging sensation, and in men, there is sometimes pain and swelling in the scrotum around the testicular area.[2] Irreducible hernias or incarcerated hernias may be painful, but their most relevant symptom is that they cannot return to the abdominal cavity when pushed in. They may be chronic, although painless, and can lead to strangulation. Nausea, vomiting, or fever may occur in these cases due to bowel obstruction. Also, the hernia bulge in this case may turn red, purple or dark and pink. Strangulated hernias are always painful and pain is followed by tenderness. Nausea and vomiting also may occur as well due to bowel obstruction. The patient may also experience fever.[3] In the diagnosis of abdominal hernias, imaging is the principal means of detecting internal diaphragmatic and other nonpalpable or unsuspected hernias. Multidetector CT (MDCT) can show with precision the anatomic site of the hernia sac, the contents of the sac, and any complications. MDCT also offers clear detail of the abdominal wall allowing wall hernias to be identified accurately.[4] [edit]Causes Causes of hiatal hernia vary depending on each individual. Among the multiple causes, however, are the mechanical causes which include: improper heavy weight lifting, hard coughing bouts, sharp blows to the abdomen, tight clothing and incorrect posture.[5] Furthermore, conditions that increase the pressure of the abdominal cavity may also cause hernias or worsen the existing ones. Some examples would be: obesity, straining during a bowel movement or urination, chronic lung disease, and also, fluid in the abdominal cavity.[6] Also, if muscles are weakened due to poor nutrition, smoking, and overexertion, hernias are more likely to occur. The physiological school of thought contends that the above mentioned are not the true causes of hernia, but are instead an (anatomical) symptom of the true (physiological) cause. Based on hundreds of observations during dissection, they have concluded that the risk of hernia is due to a physiological difference between patients who suffer hernia and those who do not, namely the presence of aponeurotic extensions from the transversus abdominis aponurotic arch. [7] When a hernia is not repaired, it may become incarcerated or strangulated. When strangulation occurs, there is a danger that part of the intestine be caught in the hernia cutting off blood supply to the tissue.

Also, when a bowel obstruction occurs, it leads to severe pain, vomiting, nausea and inability to have a bowel movement or pass gas. Men are more prone to suffer inguinal hernias than women, and they risk a damage to their testicles if a hernia becomes strangulated.[8] Also, the pressure caused on the hernia's surrounding tissues may extend into the scrotum causing pain and swelling. [edit]Diagnosis

An incarcerated inguinal hernia as seen on CT A sportman's hernia is a syndrome characterized by chronic groin pain in athletes and a dilatedsuperficial ring of the inguinal canal, although a true hernia is not present. [edit]Inguinal Main article: inguinal hernia

Diagram of an indirect, scrotal inguinal hernia (median view from the left). By far the most common hernias (up to 75% of all abdominal hernias) are the so-called inguinal hernias. Inguinal hernias are further divided into the more common indirect inguinal hernia (2/3, depicted here), in which the inguinal canal is entered via a congenital weakness at its entrance (the internal inguinal ring), and the direct inguinal hernia type (1/3), where the hernia contents push through a weak spot in

the back wall of the inguinal canal. Inguinal hernias are the most common type of hernia in both men and women. Femoral hernias occur more often in women than men, but women still get more inguinal hernias than femoral hernias. [edit]Femoral Main article: femoral hernia Femoral hernias occur just below the inguinal ligament, when abdominal contents pass into the weak area at the posterior wall of the femoral canal. They can be hard to distinguish from the inguinal type (especially when ascending cephalad): however, they generally appear more rounded, and, in contrast to inguinal hernias, there is a strong female preponderance in femoral hernias. The incidence of strangulation in femoral hernias is high. Repair techniques are similar for femoral and inguinal hernia. [edit]Umbilical Main article: umbilical hernia They involve protrusion of intraabdominal contents through a weakness at the site of passage of the umbilical cord through the abdominal wall. These hernias often resolve spontaneously. Umbilical hernias in adults are largely acquired, and are more frequent in obese or pregnantwomen. Abnormal decussation of fibers at the linea alba may contribute. [edit]Incisional Main article: incisional hernia An incisional hernia occurs when the defect is the result of an incompletely healed surgical wound. When these occur in median laparotomyincisions in the linea alba, they are termed ventral hernias. These can be the most frustrating and difficult to treat, as the repair utilizes already attenuated tissue. [edit]Diaphragmatic Main article: diaphragmatic hernia

Diagram of a hiatus hernia (coronal section, viewed from the front). Higher in the abdomen, an (internal) "diaphragmatic hernia" results when part of the stomach or intestine protrudes into the chest cavity through a defect in the diaphragm. A hiatus hernia is a particular variant of this type, in which the normal passageway through which the esophagus meets the stomach (esophageal hiatus) serves as a functional "defect", allowing part of the stomach to (periodically) "herniate" into the chest. Hiatus hernias may be either "sliding," in which the gastroesophageal junction itself slides through the defect into the chest, or non-sliding (also known as para-esophageal), in which case the junction remains fixed while another portion of the stomach moves up through the defect. Non-sliding or para-esophageal hernias can be dangerous as they may allow the stomach to rotate and obstruct. Repair is usually advised. A congenital diaphragmatic hernia is a distinct problem, occurring in up to 1 in 2000 births, and requiring pediatric surgery. Intestinal organs may herniate through several parts of the diaphragm, posterolateral (in Bochdalek's triangle, resulting in Bochdalek's hernia), or anteromedial-retrosternal (in the cleft of Larrey/Morgagni's foramen, resulting in Morgagni-Larrey hernia, or Morgagni's hernia). [edit]Other hernias Since many organs or parts of organs can herniate through many orifices, it is very difficult to give an exhaustive list of hernias, with all synonyms and eponyms. The above article deals mostly with "visceral hernias", where the herniating tissue arises within the abdominal cavity. Other hernia types and unusual types of visceral hernias are listed below, in alphabetical order:

Cooper's hernia: a femoral hernia with two sacs, the first being in the femoral canal, and the second passing through a defect in the superficial fascia and appearing almost immediately beneath the skin.

Epigastric hernia: a hernia through the linea alba above the umbilicus. Hiatal hernia: a hernia due to "short oesophagus" - insufficient elongation - stomach is displaced into the thorax Littre's hernia: a hernia involving a Meckel's diverticulum. It is named after the French anatomist Alexis Littre (16581726). Lumbar hernia (Bleichner's Hernia): a hernia in the lumbar region (not to be confused with a lumbar disc hernia), contains the following entities:

Petit's hernia: a hernia through Petit's triangle (inferior lumbar triangle). It is named after French surgeon Jean Louis Petit (16741750). Grynfeltt's hernia: a hernia through Grynfeltt-Lesshaft triangle (superior lumbar triangle). It is named after physician Joseph Grynfeltt (18401913).

Maydl's hernia: two adjacent loops of small intestine are within a hernial sac with a tight neck. The intervening portion of bowel within the abdomen is deprived of its blood supply and eventually becomes necrotic.

Obturator hernia: hernia through obturator canal Pantaloon hernia/ Saddle Bag hernia: a combined direct and indirect hernia, when the hernial sac protrudes on either side of the inferior epigastric vessels Paraesophageal hernia Paraumbilical hernia: a type of umbilical hernia occurring in adults Perineal hernia: a perineal hernia protrudes through the muscles and fascia of the perineal floor. It may be primary but usually is acquired following perineal prostatectomy, abdominoperineal resection of the rectum, or pelvic exenteration.

Properitoneal hernia: rare hernia located directly above the peritoneum, for example, when part of an inguinal hernia projects from the deep inguinal ring to the preperitoneal space. Richter's hernia: a hernia involving only one sidewall of the bowel, which can result in bowel strangulation leading to perforation through ischaemia without causing bowel obstruction or any of its warning signs. It is named after German surgeon August Gottlieb Richter (17421812).

Sliding hernia: occurs when an organ drags along part of the peritoneum, or, in other words, the organ is part of the hernia sac. The colonand the urinary bladder are often involved. The term also frequently refers to sliding hernias of the stomach.

Sciatic hernia: this hernia in the greater sciatic foramen most commonly presents as an uncomfortable mass in the gluteal area. Bowel obstruction may also occur. This type of hernia is only a rare cause of sciatic neuralgia.

Spigelian hernia, also known as spontaneous lateral ventral hernia Sports hernia: a hernia characterized by chronic groin pain in athletes and a dilated superficial ring of the inguinal canal. Velpeau hernia: a hernia in the groin in front of the femoral blood vessels Amyand's Hernia: containing the appendix vermiformis within the hernia sac Busse's Hernia: a testicle within the hernia sac

[edit]Characteristics Hernias can be classified according to their anatomical location: Examples include:

abdominal hernias diaphragmatic hernias and hiatal hernias (for example, paraesophageal hernia of the stomach)

pelvic hernias, for example, obturator hernia anal hernias hernias of the nucleus pulposus of the intervertebral discs intracranial hernias Spigelian hernia [9]

Each of the above hernias may be characterized by several aspects:

congenital or acquired: congenital hernias occur prenatally or in the first year(s) of life, and are caused by a congenital defect, whereas acquired hernias develop later on in life. However, this may be on the basis of a locus minoris resistantiae (Lat. place of least resistance) that is congenital, but only becomes symptomatic later in life, when degeneration and increased stress (for example, increased abdominal pressure from coughing in COPD) provoke the hernia.

complete or incomplete: for example, the stomach may partially or completely herniate into the chest. internal or external: external ones herniate to the outside world, whereas internal hernias protrude from their normal compartment to another (for example, mesenteric hernias). intraparietal hernia: hernia that does not reach all the way to the subcutis, but only to the musculoaponeurotic layer. An example is aSpigelian hernia. Intraparietal hernias may produce less obvious bulging, and may be less easily detected on clinical examination.

bilateral: in this case, simultaneous repair may be considered, sometimes even with a giant prosthetic reinforcement. irreducible (also known as incarcerated): the hernial contents cannot be returned to their normal site with simple manipulation.

If irreducible, hernias can develop several complications (hence, they can be complicated or uncomplicated):

strangulation: pressure on the hernial contents may compromise blood supply (especially veins, with their low pressure, are sensitive, and venous congestion often results) and cause ischemia, and later necrosis and gangrene, which may become fatal.

obstruction: for example, when a part of the bowel herniates, bowel contents can no longer pass the obstruction. This results in cramps, and later on vomiting, ileus, absence of flatus and absence of defecation.

dysfunction: another complication arises when the herniated organ itself, or surrounding organs, start to malfunction (for example, sliding hernia of the stomach causing heartburn, lumbar disc hernia causing sciatic nerve pain, etc.).

[edit]Treatment Main article: Hernia repair Hernia repair being performed aboard the amphibious assault ship USS Bataan It is generally advisable to repair hernias quickly in order to prevent complications such as organ dysfunction, gangrene and multiple organ dysfunction syndrome. Most abdominal hernias can be surgically repaired, and recovery rarely requires long-term changes in lifestyle. Time needed for recovery after treatment is greatly reduced if hernias are operated on laparoscopically, the minimally invasive operation most commonly used today.[10] Uncomplicated hernias are principally repaired by pushing back, or "reducing", the herniated tissue, and then mending the weakness in muscle tissue (an operation called herniorrhaphy). If complications have occurred, the surgeon will check the viability of the herniated organ, and resect it if necessary. Modern muscle reinforcement techniques involve synthetic materials (a mesh prosthesis) that avoid over-stretching of already weakened tissue (as in older, but still useful methods). The mesh is placed either over the defect (anterior repair) or more preferably under the defect (posterior repair). At times staples are used to keep the mesh in place. These mesh repair methods are often called "Tension Free" repairs because, unlike older traditional methods, muscle is not pulled together under tension. Evidence-based testing initially suggested that these Tension Free methods have the lowest percentage of recurrences and the fastest recovery period compared to older suture repair methods. However, prosthetic mesh usage seems to have a high incidence of infection with mesh usage becoming a study topic for the National Institutes of Health.[11] One study attempted to identify the factors related to mesh infections and found that compromised immune systems (such as diabetes) was a factor.[12] Mesh has also become the subject of recalls and class action lawsuits.[13] Laparoscopic surgery is also referred to as "minimally invasive" surgery, which requires one or more small incisions for the camera and instruments to be inserted, as opposed to traditional "open" or "microscopic" surgery, which requires an incision large enough for the surgeon's hands to be inserted into the patient. The term microscopic surgery refers to the magnifying devices used during open surgery. Many patients are managed through day surgery centers, and are able to return to work within a week or two, while intensive activities are prohibited for a longer period. Patients who have their hernias repaired with mesh often recover in a number of days. Surgical complications have been estimated to be

up to 10 percent, but most of them can be easily addressed. They include surgical site infections, nerve and blood vessel injuries, injury to nearby organs, and hernia recurrence. Generally, the use of external devices to maintain reduction of the hernia without repairing the underlying defect (such as hernia trusses, trunks, belts, etc.), is not advised. Exceptions are uncomplicated incisional hernias that arise shortly after the operation (should only be operated after a few months), or inoperable patients. It is essential that the hernia not be further irritated by carrying out strenuous labour [edit]Complications Complications may arise post-operation, including rejection of the mesh that is used to repair the hernia. In the event of a mesh rejection, the mesh will very likely need to be removed. Mesh rejection can be detected by obvious, sometimes localised swelling and pain around the mesh area. Continuous discharge from the scar is likely for a while after the mesh has been removed. An untreated hernia may be complicated by:

Inflammation Irreducibility Obstruction of any lumen, such as bowel obstruction in intestinal hernias Strangulation Hydrocele of the hernial sac Haemorrhage Autoimmune problems Incarceration, which is where it cannot be reduced, or pushed back into place,[14] at least not without very much external effort.[15] In intestinal hernias, this also substantially increases the risk of bowel obstruction and strangulation.

INGUINAL HERNIA Inguinal hernias, more commonly referred to as groin hernias, occur when your intestines are pushed through a weakness or tear in an area of the abdominal wall known anatomically as the inguinal canal, thus creating a bulge.

Inguinal hernias are by far the most common type of hernia. Since inguinal hernias are typically a result of the testis descending from the abdomen into the scrotum, these types of hernias are found in men more than women at a rate of about 10 to 1. Inguinal hernias are typically located in the area between your abdomen and thigh and can occur on one side or both sides (bilateral) of the body. Often present is a painless bulge in the groin area. Inguinal hernias are typically more visible when straining or coughing and may disappear when lying down. The presence of discomfort or pain in this area and the inability to push the bulge back into the abdomen often means the hernia may have become incarcerated or strangulated, and you should seek medical attention as soon as possible. Diagnosis of an inguinal hernia depends, in part, on your medical history and also the doctors' findings upon examination of the groin. Although some serious advances have been made in the medical field in recent years, no tests are needed to diagnose a hernia. Inguinal hernias can be acquired as the result of sudden or repetitive strain, pressure or injury which weakens the abdominal wall. However, inguinal hernias can also be congenital, or present since birth. Typically accompanied by a bulge in the groin area, inguinal hernias progressively increase in size and grow more and more uncomfortable as time goes on. In some cases, there is no visible bulge present, but rather mild pain in the groin area characterized by aching or burning sensations. This pain can be felt in the groin region, but may also be present in the leg, back and even pubic areas as a result of referred painwhich may only lessen with rest but will not completely go away. Back to top Treatment Surgical correction is necessary to repair a hernia. Hernias do not heal on their own or "just go away" and cannot be fixed with some sort of diet or exercise. The safest, most effective way to repair a hernia is with mesh in and the advanced "tension free" mesh technique as practiced here at the Hernia Center of Southern California for over ten years. This advanced technique is ideal for repairing inguinal hernias in addition to many other types of hernias.

As opposed to the "tension" method first used back in the 1800's, the highly advanced "tension free" mesh technique reduces the chance of recurrence to only 1 in 200, or 0.5%, provides shorter recovery time and greatly reduces post-operative pain. Although some "tension" methods are still in use today, we at the Hernia Center of Southern California believe in, stand behind and practice only highly advanced "tension free" hernia repair. The "tension free" technique involves the placement of synthetic mesh in the inguinal area to repair and strengthen, where as the old "tension" method involved sewing the edges of the weakness or tear back together - sometimes with muscle, sometimes not - without any reinforcement. With the "tension free" technique, we are able to tailor surgery more to the individual by selecting appropriate mesh for the shape, size and location of the individual hernia. As each of you in a unique individual, so is your hernia. We understand there is no such thing as "one size fits all" and your hernia shouldn't be handled by any type of less effective approach. The basis behind our "tension free" approach is not to create unnatural tension - where it so obviously failed before - by cutting and sewing muscles into new places, but rather to avoid tension entirely. By making effective use of sterile, flexible polypropylene mesh to reinforce and support the surrounding tissue we are able to effectively repair primary and recurrent inguinal hernias as well as most other abdominal wall hernias. The mesh assists the new tissue growth, almost like a lattice assists flowers or plants in that it acts a stable platform for the new growth to come together and strengthen upon, as it incorporates itself safely and easily into your abdominal wall. Incredibly flexible and thin, you are unable to feel the mesh and it does not inhibit activity at allafter surgery. Extending beyond the edges of the original weakness or tear, the mesh also supports the weak, thin tissue surrounding the hernia where it is most effective and will not lift or separate later with strenuous physical activity or excessive abdominal strain. We have perfected our surgical techniques in such a way that we are even able to test and maximize the strength of the hernia before surgery is complete. Our proprietary methods enable you to return to everyday activity quicker and we guarantee surgery FOR LIFE. Not only that, but our surgical methods are: Safe Effective Fully Approved Designed for Fast Return to Everyday Activity Provide Minimum Post-Operative Pain Less Physically Restrictive Achieve High Patient Satisfaction

Understanding your unique situation and needs is first and foremost for us at the Hernia Center of Southern California, which is why we don't perform one type of procedure on everyone, but rather choose methods best suited to you. Our philosophy carries over into our surgical techniques allowing us to specially repair your hernia in a way best suited to our hernia specialists findings during surgery. We offer our advanced surgical techniques to you with the reassurance you are receiving the best possible care and repair for your hernia. Since our techniques are "tension free" your risk of post-operative pain, problems, and recurrence is extremely low and you can rest assured you will be returning to your regular, everyday activities with fewer restrictions, quicker.

Inguinal hernia surgery is generally performed under a local anesthesia with sedation and patients are typically allowed to return home the same day, often requiring little or no medication. Since our surgeons and staff here at the Hernia Center of Southern California are fully trained in our advanced surgical techniques for abdominal hernias, we encourage patients to walk and move immediately after surgery in every effort to return you to your everyday activities within days, minimizing your down time and any additional inconveniences. INGUINAL HERNIA SURGERY

Inguinal hernia surgery involves repair of the abdominal wall, returning the hernia and its contents internally back to into normal position and closing the defect in the abdominal wall with a nonreactive mesh. The type and size of mesh will be individualized separately for each patient by the surgeon at the time of surgery in order to achieve the best possible result. We have extensive experience performing surgery to suit each individual hernia with the added experience of having performed over 7,500 hernia operations. The surgical technique we use for hernia repair is called the Tension Free Mesh technique. This technique, along with our experience, ensures that your surgery is safe and successful with minimal discomfort. In most cases, surgery will be performed under local anesthesia with sedation. Back to top Local Anesthesia with Sedation This is our preferred method of anesthesia. In fact, 90% of our patients receive this method of anesthesia. In the operating room you will receive only one simple stick for starting the intravenous line while you are awake. You are then given the anesthetic medications through the intravenous line so that you will not feel any pain. You are given medication for pain and to relax you. You will very gradually drift into a pleasant sleep. Once you are asleep the local anesthesia is given. The substance used for local anesthesia is similar to the Novacain your dentist may use, however, we use a combination of two medications. One is Lidocaine, a short acting local anesthetic that will insure you a pain free surgery. The second medication is Marcaine with Epinephrine, which is a long acting local anesthetic. Marcaine will provide local anesthesia that will last up to four or six hours. Therefore, after your surgery you will be pain-free for several hours so you can return to the comfort of your home. When you wake up at the end of the surgery you are still in the operating room. The operating room staff will assist you to walk to the recovery room. Since you are asleep there is no pain at the time of the initial local anesthetic injection and no pain at the time of surgery. This is our preferred method of anesthesia because it is pain-free, very safe, and has a minimal amount of side effects. This method lacks the side affects of general anesthesia which can, on occasion, cause sore throat, headache or vomiting. With this method patients are minimally disoriented. Patients are discharged the same day as surgery with a prescription for pain pills. After a couple of days most patients will require only over-the-counter pain pills and will be able to return to their normal daily activities, including driving. All patients will experience numbness inthe region of the surgery.

Since we are experienced in hernia repair, we are considered true hernia specialists. Due to our knowledge and expertise in the field of hernia repair, our results are better than the national average, however, we are required to inform our hernia patients regarding the complications of hernia surgery. The results of the national average are listed below. Recurrence of the Hernia*....................................0.5% or 1 in 200. *(Recurrent hernia usually occurs in obese patients or in patients who have already undergone a prior hernia repair.) Infection of incision ..............................................0.5% or 1 in 200 Bleeding after surgery..........................................1% or 1 in 100 Change in testicular size and function...............1% or 1 in 100 Injury to the bowel, bladder or bowel .........0.025% or 1 in 400 Injury to the Vas deferens ............0.025% or 1 in 400 Temporary chronic incisional pain lasting 2-3 months................................3 to 5% or 3-5 in 100 Mild chronic incisional pain w/neuroma formation, non-dehabilitating ....1% or 1 in 100 Chronic incisional pain w/neuroma formation can be dehabilitating ....0.5% or 1 in 200 Temporary swelling, or black and blue after surgery, lasting about 1 week*.... 10% or 1 in 10 *(This is not considered a complication) Most of the numbness will gradually resolve as the nerves regenerate. However, in most instances, there will be a small area the size of a quarter just below the incision where the numbness will be permanent. The numbness will be barely noticeable and will not alter any normal function. Numbness is not considered a complication. Patients with recurrent hernias have a higher complication rate than patients who are undergoing their surgery for the first time.