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Hernia Surgery Simplified
Sachin Kuber
CHAPTER 1:
Milestones in Hernia Surgery
Introduction
At a Glance
History of the Procedure
CHAPTER 2:
Surgical Anatomy of Hernia Sites
Surgical Anatomy of Hernia Sites
Anatomy of the Abdomen and Groin
External Anatomy of Abdominal Wall—The Surface Markings
Anterior Abdominal Wall Anatomy
Surface Anatomy
The Fascia
Superficial Fascia
Deep Fascia
Subserous and Peritoneal Fascia
Rectus Abdominis and Rectus Sheath
Lateral Muscles
Musculofascial Layer
External Oblique (Fig. 2.9)
Internal Oblique (Figs 2.6 and 2.10)
Transversus Abdominis
Fascia Transversalis
Borders
Opening
Transversalis Fascia
Bogros' Space (Fig. 2.14)
Pyramidalis (Fig. 2.16)
Arcuate Line (Fig. 2.17)
Linea Alba
Linea Semilunaris
Importance of Langer's Lines in Hernia Surgery
History
Uses
Vascular Supply of Abdomen
Vascular Supply and Innervation
Study by Huger et al Classified the Vascular Blood Supply of the Abdominal Wall into Three Simple Zones
Blood Supply (Table 2.2)
Innervation
Lymphatic Drainage
Posterior Abdominal Wall
Major Muscles of the Posterior Abdominal Wall
Blood Supply to the Posterior Abdominal Wall
Blood Supply of Posterior Abdominal Wall (Figs 2.21A and B)
Crura of Superficial Inguinal Ring
Superficial Inguinal Ring (Fig. 2.22)
Deep Inguinal Ring (Fig. 2.19)
Inguinal Ligament (Fig. 2.24)
Eponym
Spermatic Cord
Conjoint Tendon (Fig. 2.27)
Clinical Significance
Femoral Canal (See Fig. 2.13)
Structure
Subdivisions
Development
Importance
Radiological Anatomy
Herniography
Diaphragm (Fig. 2.29)
Anatomy
Innervation
Crura and Central Tendon
Openings in the Diaphragm (Table 2.5 and Fig. 2.30)
Esophageal Hiatus
CHAPTER 3:
Incidence, Prevalence of Hernia
Incidence, Prevalence of Hernias (Abdominal)
Inguinal Hernias in Adults
Inguinal Hernias in Children
Femoral Hernias in Adults
Epidemiology
Umbilical Hernia
Epigastric Hernia
Hiatal Hernia
Frequency
United States
Frequency at a Glance
Epidemiology of Inguinal Hernia Survey Results
CHAPTER 4:
Etiology of Herniation
Etiology
Theories for Hernia Formation
Pathophysiology
Inguinal Hernias
Mechanism of Hernia of the Groin
List of Causes of Inguinal Hernia
Inguinal Hernia as a Complication of other Conditions
Inguinal Hernia as a Symptom
Causes for Inguinal Hernia
Inguinal Hernia—Risk Factors Prematurity
Inguinal Hernia—Pathophysiology
Umbilical Hernias
Causes of Umbilical Hernia that are Very Rare
Causes of Umbilical Hernia without any Prevalence Information
All Causes of Umbilical Hernia
Congenital Abdominal Wall Defects
Other Hernias
Femoral Hernia (Fig. 4.5)
Causes of Femoral Hernia
CHAPTER 5:
Prosthesis Used in Hernioplasty
Use of Prosthetics in Hernia Repair
Indications for Use of Prosthesis in Hernia Repair
Causes of Loss of Musculofascial Tissue
Aging Effects
Denervation Effect
What makes the Ideal Prosthetic?
Prosthetics for Inguinal Hernia Repair
Prosthetic Biomaterial—Absorbable Type
Collagen Containing Mesh
Permacol (Fig. 5.1)
AlloDerm Mesh (Fig. 5.2)
AlloDerm
Surgisis Mesh (Figs 5.5 and 5.6)
Flat Nonabsorbable/Partially Absorbable Mesh
Polypropylene Prosthetic Mesh (Flat Type)
Actions
Indications
Contraindications
Ultrapro (Poliglecaprone-25/Polypropylene)Synthetic Partially Absorbable Mesh
Open-Skirted Flap for Increased Rigidity and Accessible Fixation
Reliable Treatment for Paraesophageal and Hiatal Hernia (Fig. 5.14)
Devices for Inguinal Hernioplasty
Prolene* Polypropylene Hernia System (Fig. 5.15)
Using the Sytem
Ultrapro* Hernia System (Fig. 5.16)
Ventral/Incisional or Umbilical Hernias
Ultrapro* Plug (Figs 5.17A to D)
Prolene 3D Patch
Proceed* Surgical Mesh
Actions/Performance
Indications
Instructions
Proceed* Ventral Patch
Description
Actions/Performance
Indications
Instructions for Use
Hernia Repair Technique
Polytetrafluoroethylene
Prosthetics without a Barrier
Prosthetics with Absorbable Barriers
Preshaped Mesh Device for Inguinal Hernia
Bard® 3DMax® Mesh (Figs 5.18 to 5.20)
Bard Visilex Mesh (Fig. 5.21)
Gore Dualmesh® Biomaterial (Fig. 5.22)
Indications
Surface Orientation
Suturing
Other Fixation Devices
Complications Related to the Use of Prosthetics
CHAPTER 6:
Classification of Hernia
Classification of Abdominal Hernia
Classification of Groin Hernias
The Most Popular Classifications
Endoscopic/Laparoscopic Classification of Hernia
Classification of Inguinal Hernia for Total Extraperitoneal Repair
Classification of Ventral Hernia
Types of Abdominal Hernia
Other Abdominal/Inguinal Hernias
CHAPTER 7:
Diagnosis of Hernia
Presentation of Hernia
Inguinal Hernia
Examination of an Adult
In Children
Incarcerated Hernia
Strangulated Hernia
Reducible Hernia
Irreducible Hernia
Other Hernias
Spigelian Hernia
Femoral Hernia
Diagnosis
Epigastric Hernia
Umbilical Hernia
Presentation
Differential Diagnosis
Paraumbilical Hernia
Hiatus Hernia
Symptoms
Diagnosis
Incisional Hernia
Obturator Hernia
Perineal Hernia
Petit's Hernia
Grynfeltt-Lesshaft Hernia
Sciatic Hernia
Diastasis Recti
Interparietal Hernia
Monolocular Properitoneal Hernia
Symptoms
Interstitial Hernia
Superficial Hernia
Diaphragmatic Hernia
Congenital Abdominal Wall Defects
Radiology in Hernia Diagnosis
Peritoneography/Herniography
Indications
Herniography Technique
Ultrasonography
Inguinal Hernia (Fig. 7.10)
Indirect Inguinal Hernia (Fig. 7.11)
Direct Inguinal Hernia
Femoral Hernia (Fig. 7.12)
Spigelian Hernia (Fig. 7.13)
Scrotal Hernias (Fig. 7.14)
Dynamic Ultrasound Versus a CT or MRI Scan for Diagnosing Hernias
Computed Tomography
Obturator Hernia (Fig. 7.15)
Incisional Hernia
Barium Swallow for Hiatus Hernia (Fig. 7.17)
Endoscopy for Hiatus Hernia (Fig. 7.18)
Magnetic Resonance Imaging
Indications
CHAPTER 8:
Principles of Hernia Repair
Current Guidelines in Hernia (Abdominal) Surgery
Hemostasis
Infection
Wound Repair
Phases of Wound Healing
Inflammatory Phase
Proliferative Phase
Remodeling Phase
Wound Healing in the Presence of Prosthetic Mesh
Causes of Delayed Wound Healing
It is Better Practice to Avoid all these Above Listed Causes to Achieve Successful Hernia Repair
Suturing Materials
Placement of Prosthetic Mesh
CHAPTER 9:
Anesthesia in Hernia Surgery
Anesthesia for Hernia Repairs
Anesthesia Used in Hernia Repairs
General, Spinal, Epidural, Local Anesthesia are Best Suited for Hernia Repairs
Local Anesthesia for Hernias (Inguinal)
Introduction
Advantages of Local Anesthesia
Disadvantages of Local Anesthesia
Local Anesthetic Agents
Technique
Anatomy
Method—Step-by-Step (Figs 9.1 and 9.2)
Complications
Toxicity of Local Anesthetic Agents
CHAPTER 10:
Open Anterior Repair of Inguinal Hernia in Adult
Techniques of Open Anterior Inguinal Hernia Repair
Techniques of Hernia Repair
Anterior Rrhaphies
Anterior Plasties
Posterior Rrhaphies
Posterior Plasty
Laparoscopic Hernia Repair
Details of Procedure
Lytle and Marcy Repair
Bassini Repair (Fig. 10.2)
The Incision
Shouldice Repair
Inguinal Dissection
Reconstruction
Postoperative Course
The Repair Technique (Other Way Around)
Advantages and Disadvantages
Currently Used Other Tension-Free Techniques
Equipment
Positioning
Technique
CHAPTER 11:
Laparoscopic Inguinal Hernia Repairs
Introduction
Definitions
Anatomy-Understanding
Laparoscopic Inguinal Anatomy
Indications
Contraindications
Anesthesia
Equipment (Fig. 11.8, Table 11.1)
Positioning
Technique TEP—Total Extraperitoneal Repair
Balloon Dissection (Fig. 11.10)
Trocar Placement (Fig. 11.11)
Direct Space Dissection (Fig. 11.12)
Lateral Abdominal Wall Dissection
Indirect Sac Isolation
Mesh Deployment and Fixation
Important Tips
Desufflation
Complications
Transabdominal Preperitoneal Hernia Repair (Figs 11.14A to F)
Patient Selection
Anesthesia
Standard Technique of Transabdominal Preperitoneal Hernia Repair (Fig. 11.15)
Step 1: Entering the Intra-abdominal Cavity
Step 2: Creating the Peritoneal Flap
Step 3: Identifying the Anatomical Landmarks
Step 4: Dissecting the Hernia Sac
Step 5: Deploying and Anchoring the Mesh (Figs 11.21A and B)
Step 6: Testing the Fixation of the Mesh (Fig. 11.22)
Step 7: Closing the Peritoneum
Intraoperative Complications
Final Word
CHAPTER 12:
Female Inguinal Hernia
Anatomy and Surgery Techniques
Anatomy (Table 12.1)
Site
Length
Direction
Boundaries
Contents
Female Inguinal Hernia (Fig. 12.1)
In Females
Symptoms
Formation
Operative Technique
CHAPTER 13:
Pediatric Inguinal Hernia
Inguinal Hernia in Children
Introduction
Pathophysiology
Some Statistics
Mortality/Morbidity
Sex
Age
Etiology of Inguinal Hernias in Children
Fast Facts
Hydrocele and Hernia in Children Varicocele in Adolescents
Other
Classification—Inguinal
Clinical Examination
Management
Irreducible Hernias
Surgical Care
Repair of the Pediatric Inguinal Hernia
Exploration of the Contralateral Side
Disadvantages
Management of Incarcerated Hernia
Manual Reduction of Incarcerated Hernia
Laparoscopic Needle-assisted Repair of Inguinal Hernia
Further Inpatient Care
Complications
Prognosis
CHAPTER 14:
Femoral Hernia
Surgery
Anatomy
Femoral Hernia
Coverings of a Femoral Hernia
Saphenous Opening
Causes of Femoral Hernia
Demographics
Classification
Signs and Symptoms
Diagnosis
Femoral Hernias (Figs 14.6A and B)
Management of Femoral Hernias
Surgery
Lockwood's Infrainguinal Approach
Preoperative Management
Anesthesia (Figs 14.7 to 14.12)
Conclusion
Lotheissen's Transinguinal Approach
Procedure
McEvedy's High Approach (Extraperitoneal Operation)
Laparoscopic Repair for Femoral Hernia
Morbidity and Mortality Rates
CHAPTER 15:
Umbilical Hernia
Umbilical Hernias (Figs 15.1A and B)
Risk
Incidence and Prevalence
Diagnosis
History
Physical Examination
Tests
Treatment (Figs 15.2A to E)
Truss
Epidemiology and Pathology
Outlook
Mayo's Procedure for Umbilical Hernia
Indications of Umbilical Hernia Surgery
Absolute Contraindications for Surgery
The Surgery
Open Technique of Repair
Incision
Sac
Repair with Prolene Hernia System (Figs 15.3A and B)
Laparoscopic Repair
CHAPTER 16:
Epigastric Hernia
Epigastric Hernia
Investigations
Pathological Anatomy
The Muscles and Fasciae of the Abdomen
Epigastric Hernia Surgery
Complications of Epigastric Hernia Operation
CHAPTER 17:
Incisional/Ventral Hernias
Incisional/Ventral Hernia Surgery
Demographics
Symptoms and Signs
Etiological Factors of Incisional Hernia
Diagnosis
Physical
Examination
Classification
Lateral Hernias (Fig. 17.2)
Preparation for Surgery
Indications for Incisional Hernia Repair
Treatment
Open Prosthetic Incisional Hernia Repair
Position: Supine on Operating Table
Repair of Defect
Preparation of Mesh
Laparoscopic Incisional Hernia Repair
Laparoscopic Ventral Hernia Repair
Patient Selection and Preoperative Care
Preparation and Instrumentation
Operative Procedure
Rives-Stoppa Ventral Hernia Repair
Complications of Ventral Hernia Repair
Bowel Injury
Bleeding
Postoperative Complications
Pain
Wound Complications/Fluid Collections
Recurrence
CHAPTER 18:
Lumbar Hernia (Types of Lumbar Hernia Surgery)
Hernia of the Superior Lumbar Triangle
Anatomy (Figs 18.1A and B)
Superior Triangle of Grynfeltt and Lesshaft
Boundaries (Figs 18.2 and 18.3)
Etiology
Presentations
Complications
Lumbar Hernia: Diagnosis by CT
Differential Diagnosis
Treatment
Surgery for Lumbar Hernia
Objectives
Procedure
Treatment
Laparoscopic Retroperitoneal Repair
CHAPTER 19:
Spigelian Hernia
Definition
Occurrence
Symptoms
Diagnosis
Clinical Examination
Differential Diagnosis
Investigations
Ultrasonography
Computed Tomography (Figs 19.4 and 19.5)
Treatment
Preoperative Care
Conventional Open Surgical Approach
Laparoscopic Surgery for Spigelian Hernia
Intraperitoneal Onlay Mesh Repair
Transabdominal Preperitoneal Repair (Fig. 19.6)
Total Extraperitoneal Repair (Fig. 19.7)
CHAPTER 20:
Pelvic Hernias
Obturator Hernia
Howship-Romberg Sign
Contents of Hernia
Anatomy
Demographics and Clinical Presentation
Stages of Hernia Formation
Radiographic Features
Symptoms
Diagnosis
Clinical Tests
Radiology
Radiographic Features
Management
Surgical Anatomy
Surgery
Preoperative Hemodynamic Consideration
Abdominal Approach
Obturator Approach
Inguinal Approach
Sciatic Hernia
Treatment
Transabdominal Approach
Laparoscopic Approach
Perineal Hernias
Perineum
The Muscles of the Anal Region
The Muscles of the Urogenital Region in the Male (Fig. 20.8)
The Muscles of the Urogenital Region in the Female (See Fig. 20.9)
Clinically
Treatment
INDEX
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