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.