ing hernias

7/26/2019 Ing Hernias

1/39

Hernia,

Hydrocele

Stephen Confer, MDBen O. Donovan, MD

Brad Kropp, MD

Dominic Frimberger, MD

Univerity of O!lahoma

Department of UrologySection of "ediatric Urology


2/39

# year old male


3/39

$ncarcerated $ng%inal Hernia


4/39

Hernia &ed%ction

From Surgery of Infants and Children, Oldham, et. al., 1997

' Unable to red%ce( O&

' $f e)tremely diffic%lt *edation+( repair ne)t day

' $f able to red%ce itho%t edation( repair oon


5/39

$ng%inal Hernia

From Atlas of Pediatric Surgery, Ashcraft, 1994

' Mot can be red%ced in clinic or -D

' Boel %%ally OK if able to red%ce

' /0 reincarceration rate

' Beare the 1ing%inal node2 in female

3 incarcerated ovary


6/39

Overvie

' &evie 4natomy

' Biotatitic

' Operative Decription' 4dvanced

5aparocopic4natomy

' -BM6CoreCompetency


7/39

D-F$7$8$O7

' 9:..an abnormal

protr%ion of a vic%

thro%gh it containingall9


8/39

4natomy


9/39


10/39

BOU7D4&$-S OF $7;U$745

C4745' F5OO&( $ng%inal ligament

' 478-&$O&


11/39

$ng%inal?Scrotal 4natomy

From Surgery of Infants and Children, Oldham, et. al., 1997


12/39

CO78-78S OF C4745

3 ARTERIES:

' 8etic%lar 4rtery

' 4rtery to @a' 4rtery to cremater

3 NERVES:

' ;enital branch of

genitofemoral nerve

' Sympathetic fibre

' $lioing%inal nerve

3 LAYERS OF FASCIA:

' -)ternal permatic facia' Cremateric facia

' $nternal permatic facia.

3 OTHERS:

' @a deferen' "anpiniform ple)%

' 5ymphatic


13/39

4748OM$C45 D-F$7$8$O7

INDIRECT

' 5ateral to $-4

' O%tide Haelbachtriangle.

' 8herefore hernia goe

from D& S& crot%m.

' 8herefore, indirectherniasare controlled A

dee ring

DIRECT

' Medial to $-4

' $nide Haelbachtriangle.

' $t i a b%lge in faciatranverali.

' 8herefore if b%lgemedial to finger atdeep ring it i direct.


14/39


15/39

4748OM$C45 D-F$7$8$O7

' 7ote that crotal elling are %%ally

indirect.

' Hoever, large direct can cro %perficial

ring and enter the crot%m. 8hi i rare.

' 4n indirect and direct hernia occ%rring

im%ltaneo%ly i termed a pantaloonhernia.


16/39

Biotatitic

' 4ll age

' Both e)e

' 0 $ncidence( $ng%inal 0

$nciional 0

Femoral /0


17/39

Biotatitic

' 4ppro)imately /, hernia repair areperformed a an o%tpatient proced%re each year

' 4ppro)imately /0 of all hernia occ%r in theing%inal region

' 4ppro)imately 0 of hernia are indirecting%inal hernia

' 4 vat ma>ority occ%r in male' Hernia more commonly occ%r on the right ide


18/39

-tiologie

Increased Abdominal

Pressre(

' Heavy lifting

' Chronic co%gh

' B"H

' Contipation

' 4cite

!ea"ened Abdominal

!all:

'$ncreaing age

' Maln%trion

' Collagen diorder

' Smo!ing


19/39

Diagnoi

' 8hey may decribe minor pain or vag%e

dicomfort aociated ith the b%lge

' -)treme pain %%ally repreent

incarceration ith intetinal vac%lar

compromie

' "aretheia may be preent if ing%inalnerve are compreed


20/39


21/39

S%rgical Management of $ng%inal

Hernia' $ng%inal hernia ho%ld be %rgically repaired

folloing diagnoi by phyical e)am

' 8he nat%ral hitory of groin hernia i one ofprogreive enlargement and ea!ening ith thepotential for incarceration and obtr%ction of theintetine

' Hernia do not reolve pontaneo%ly or improveith time

'


22/39

8he Operation

' 8he inciion i made to finger breadth above the ing%inalligament

' Caref%l diection thro%gh the %bc%taneo% and e)ternal

obli=%e facia i made' 8he permatic cord i mobiliEed

' 8he cremateric m%cle fiber are divided and eparated from%nderlying cord tr%ct%re

' 8he hernia ac i diected from the cord tr%ct%re and opened' 8he nec! of the ac i %t%re6ligated at the level of the internal

ring *e)ce ac i removed+


23/39


24/39


25/39


26/39


27/39


28/39


29/39

Specific S%rgical "roced%re

' 5aparocopic hernia repair

3-arly attempt re%lted in e)ceptionally high

reocc%rrence rate


30/39


31/39


32/39


33/39


34/39


35/39

Practice !ased learning and

imro"ement' "ropective &andomiEed Controlled 8rial to

compare !in taple and polypropylene for

ec%ring the meh in ing%inal hernia repair.' Britih o%rnal of S%rgery GG, ,/G6

/G. &atliff et. al.


36/39

Compare fi)ation method

' men %nilateral ing%inal repair

' &eeval%ation in I and ee!.

' Staple time min

' S%t%re time G

'7o difference in pain core


37/39

Dia#noseCorrec$l%Per&ormSa&eIn$er'en$

ionsHerniaSr'i'ors()an*++,


38/39

$ng%inal hernia in b%ll$ng%inal hernia in b%ll


39/39

ing hernias

Documents