groin hernia repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular...
TRANSCRIPT
![Page 1: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/1.jpg)
Hernias
Dr Omar Mansour
FRCS FRCSI UEMS MRCSI MSc MB
BCh BAO Arab Brd Jord Brd
![Page 2: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/2.jpg)
• Definitions
• Groin
• Incidence
• Indications for surgery
• Complications
• Types of surgery
• Know your anatomy, AGAIN!
![Page 3: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/3.jpg)
![Page 4: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/4.jpg)
![Page 5: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/5.jpg)
![Page 6: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/6.jpg)
![Page 7: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/7.jpg)
Inguinal hernias
![Page 8: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/8.jpg)
![Page 9: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/9.jpg)
![Page 10: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/10.jpg)
![Page 11: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/11.jpg)
![Page 12: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/12.jpg)
![Page 13: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/13.jpg)
![Page 14: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/14.jpg)
![Page 15: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/15.jpg)
![Page 16: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/16.jpg)
![Page 17: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/17.jpg)
![Page 18: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/18.jpg)
1. Inguinal ligament
2. Muscular part of
transversus abdominus
3. Tranversus abdominus
aponeurosis
4. Muscular part of internal
oblique
5. Internal oblique
aponeurosis
6. Transversalis fascia
7. Cremasteric fascia over
spermatic cord
8. Pubic tubercle
![Page 19: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/19.jpg)
Umbilical hernias
![Page 20: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/20.jpg)
![Page 21: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/21.jpg)
![Page 22: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/22.jpg)
![Page 23: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/23.jpg)
![Page 24: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/24.jpg)
![Page 25: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/25.jpg)
![Page 26: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/26.jpg)
Decision to operate
• Careful examination
– Erect and supine
– Direct/indirect or pantaloon?
– Is there a cough impulse…if so hernia or
saphena varix? If not, is it strangulated?
– Don’t forget the scrotum, can you get above it?
![Page 27: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/27.jpg)
Which Procedure
• Open/ Laparoscopic
• Darn, Shouldice or
Lichtenstein (mesh)?
• Local/general/regional
anaesthesia?
![Page 28: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/28.jpg)
Local Anaesthesia
• Compliant patient
– Adequate monitoring
– Resusitation available if adverse reaction
• Sufficient volume required
• 100mls 0.5% lignocaine +1/100,000 adrenaline
– 20mls along incision line
– 25mls deep (superficial to inguinal canal)
– 5-10mls ilioinguinal block
– 50mls during procedure as required
![Page 29: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/29.jpg)
![Page 30: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/30.jpg)
Open Hernia Repair
• Open inguinal canal
• Protect the ilioinguinal nerve
• Isolate the cord
• Identify and reduce/resect hernia sac
• Repair the defect
![Page 31: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/31.jpg)
![Page 32: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/32.jpg)
![Page 33: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/33.jpg)
![Page 34: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/34.jpg)
![Page 35: Groin Hernia Repair - كلية الطب...in groin. (see lower limb pulses and cardiovascular examination). Midpoint of inguinal ligament Half way between ASIS and pubic tubercle -](https://reader033.vdocuments.mx/reader033/viewer/2022050515/5f9edc02277be556691c029c/html5/thumbnails/35.jpg)