Overview
What techniques are commonly used for inguinal hernia repair?
What are the indications of an open inguinal hernia repair?
What are the contraindications of an open inguinal hernia repair?
What equipment is needed for an open inguinal hernia repair?
What types of anesthesia are used during an open inguinal hernia repair?
What are the types of open inguinal hernia repair?
What is a Lichtenstein tension-free mesh repair?
What are surgical technique options for open inguinal hernia repair?
What are inguinal hernias and what is the frequency of open surgical repair?
What are the different types of hernias requiring open surgical repair?
What are the types of open inguinal hernia repair?
What are the advantages and disadvantages of open and laparoscopic repair of inguinal hernias?
What are indications for an open inguinal hernia repair?
What are contraindications for open inguinal hernia repair?
What is the relevant anatomy for open inguinal hernia repair?
What are the anatomical details of the inguinal canal in an open inguinal hernia repair?
What are the anatomical details of the spermatic cord in an open inguinal hernia repair?
Which key nerves are taken into account when performing an open inguinal hernia repair?
What are the anatomical features of the key nerves in an open inguinal hernia repair?
What is the role of mesh in an open inguinal hernia repair?
What is a common complication of open inguinal hernia repair?
How are causalgia syndromes prevented during open inguinal hernia repair?
How can postherniorrhaphy pain after an open inguinal hernia repair be prevented?
How are complications of open inguinal hernia repair prevented in children?
How are vascular injuries prevented during open inguinal hernia repair?
Which factors should be controlled prior to performing an open inguinal hernia repair?
What size mesh is optimal for open inguinal hernia repair?
How are infections prevented following an open inguinal hernia repair?
What is the efficacy of open inguinal hernia repair?
Periprocedural Care
What are preprocedural consideration for an open inguinal hernia repair?
What equipment is needed for an open inguinal hernia repair?
What types of anesthesia are used during an open inguinal hernia repair?
What is the basis for selection of anesthesia technique for an open inguinal hernia repair?
What are the commonly used local anesthetics for an open inguinal hernia repair?
How is a field block administered for an open inguinal hernia repair?
What is the role of antibiotic prophylaxis in open inguinal hernia repair?
How is the patient positioned for an open inguinal hernia repair?
What are the monitoring and follow-up protocols for an open inguinal hernia repair?
Technique
What are the types of open inguinal hernia repair?
How is the inguinal canal exposed in the Lichtenstein tension-free mesh repair?
How is the spermatic cord managed in the Lichtenstein tension-free mesh repair?
How is the hernia sac identified and managed in the Lichtenstein tension-free mesh repair?
How is the mesh placed and fixed in the Lichtenstein tension-free mesh repair?
What are the closure protocols in the Lichtenstein tension-free mesh repair?
When are approaches other than Lichtenstein tension-free mesh repair indicated?
What is a plug-and-patch repair technique for open inguinal hernia repair?
What is a Prole Hernia System technique for open inguinal hernia repair?
What is the McVay repair technique for open inguinal hernia repair?
What is the Bassini repair technique for open inguinal hernia repair?
What is the Shouldice repair technique for open inguinal hernia repair?
What is the Darn repair technique for open inguinal hernia repair?
What is an acellular dermal implant for open inguinal hernia repair?
What is included in postoperative care of an open inguinal hernia repair?
What is the risk of complications following an open inguinal hernia repair?
What are the intraoperative complications of an open inguinal hernia repair?
What causes vascular injury in open inguinal hernia repair?
What causes abdominopelvic structure injuries in open inguinal hernia repair?
How do nerve injuries complicate an open inguinal hernia repair?
What is the prevalence of urinary retention following open inguinal hernia repair?
How are postoperative seromas and hematomas managed following open inguinal hernia repair?
What are the risks of infection following open inguinal hernia repair?
How is pain managed following open inguinal hernia repair?
What are possible scrotal complications of open inguinal hernia repair?
How are ischemic orchitis and thrombosis managed following open inguinal hernia repair?
What is the recurrence rate following open inguinal hernia repair?
Medications
What are the goals of drug treatment for open inguinal hernia repair?
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Anatomy of inguinal canal.
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Anatomy of nerves of groin.
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Open inguinal hernia repair. Skin incision.
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Open inguinal hernia repair. Division of external oblique aponeurosis.
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Open inguinal hernia repair. Cord structures and hernia sac encircled by Penrose drain.
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Open inguinal hernia repair. Hernia sac separated from cord structures.
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Open inguinal hernia repair. Development of preperitoneal space.
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Open inguinal hernia repair. Deployment of Prolene Hernia System (PHS).
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Open inguinal hernia repair. Final position of Prolene Hernia System (PHS) mesh.
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Open inguinal hernia repair. Closure of external oblique aponeurosis.
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Open inguinal hernia repair. Skin closure.
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Open inguinal hernia repair. Draping and incision.
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Open inguinal hernia repair. External oblique aponeurosis with external inguinal ring.
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Open inguinal hernia repair. External oblique aponeurosis with external inguinal ring.
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Open inguinal hernia repair. Reflected part of inguinal ligament exposed for fixing inferior edge of mesh.
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Open inguinal hernia repair. Inferior flap of external oblique aponeurosis developed to expose inguinal ligament from pubic tubercle to midinguinal point.
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Open inguinal hernia repair. Superior flap of external oblique aponeurosis is developed as high as possible to provide ample space for mesh placement.
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Open inguinal hernia repair. Lifting up cord with hernia sac medial to external inguinal ring.
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Open inguinal hernia repair. Avascular plane between posterior inguinal wall and cord structures.
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Open inguinal hernia repair. Cord structures and hernia sac looped along with ilioinguinal and genitofemoral nerves.
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Open inguinal hernia repair. Cremaster muscle picked up to be incised longitudinally between hemostats.
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Open inguinal hernia repair. Indirect hernia sac dissected and being separated from lipoma of cord and cord structures.
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Open inguinal hernia repair. Lipoma of cord dissected free and excised.
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Open inguinal hernia repair. Indirect hernia sac separated from cord structures in midinguinal region toward neck of sac.
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Open inguinal hernia repair. Voluminous indirect hernia sac separated from cord structures in midinguinal region up to neck of sac.
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Open inguinal hernia repair. Hernia sac being divided near neck.
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Open inguinal hernia repair. Contents of hernia sac reduced and proximal end to be sutured closed.
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Open inguinal hernia repair. Anterior wall of distal sac incised to prevent hydrocele formation.
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Open inguinal hernia repair. Fixation of lower edge of mesh.
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Open inguinal hernia repair. First medialmost stitch in mesh, fixed about 2 cm medial to pubic tubercle, where anterior rectus sheath inserts into pubis.
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Open inguinal hernia repair. Same suture is utilized as continuous suture to fix lower edge of mesh to reflected part of inguinal ligament up to internal ring.
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Open inguinal hernia repair. Lower edge of mesh sutured to inguinal ligament up to internal inguinal ring. To accommodate cord structures, lateral end of mesh is divided into wider upper (two thirds) tail and narrower lower (one third) tail.
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Open inguinal hernia repair. Wider upper tail of mesh is passed underneath cord, and mesh is placed posteriorly in inguinal canal behind spermatic cord.
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Open inguinal hernia repair. Fixation of upper edge of mesh.
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Open inguinal hernia repair. Slit made in mesh to accommodate iliohypogastric nerve. Two interrupted sutures are taken under vision to fix upper edge of mesh while safeguarding iliohypogastric nerve.
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Open inguinal hernia repair. Upper tail is crossed over lower tail around spermatic cord, thus creating internal ring. Lower edges of two tails are tucked together to inguinal ligament just lateral to internal ring.
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Open inguinal hernia repair. Tails are then passed underneath external oblique aponeurosis to give overlap of about 5 cm beyond internal ring.
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Open inguinal hernia repair. External oblique aponeurosis sutured with 2-0 polypropylene.
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Open inguinal hernia repair. Subcutaneous tissue approximated with 3-0 plain catgut.
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Open inguinal hernia repair. Skin approximated with 2-0 polypropylene subcuticular suture.
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Hesselbach triangle. Image courtesy of Wikimedia Commons.