6. Treatment of Oblique and Direct inguinal hernia Flashcards Preview

Surgery.(General 1).Hernia > 6. Treatment of Oblique and Direct inguinal hernia > Flashcards

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1

Treatment of Oblique inguinal hernia

1. Truss


2. Surgical treatment

2

Disadvantage of Truss in Treatment of Oblique inguinal hernia

Predispose to:

* Strangulation

* Hydrocele of hernial sac

3

Surgical treatment in Treatment of Oblique inguinal hernia

* The only curative treatment

* Modalities

* Surgical details

4

Modalities of Surgical treatment in Treatment of Oblique inguinal hernia

* Herniotomy

* Herniorrhaphy

* Hernioplasty

5

Herniotomy in Modalities of Surgical treatment in Treatment of Oblique inguinal hernia

* Principle

* Indication

6

Principle of Herniotomy in Modalities of Surgical treatment in Treatment of Oblique inguinal hernia

Excision of the hernial sac up to the neck.

7

Indication of Herniotomy in Modalities of Surgical treatment in Treatment of Oblique inguinal hernia

This is sufficient in children with congenital hernia when the musculature is good & the only problem is performed sac

8

Principle of Herniorrhaphy in Modalities of Surgical treatment in Treatment of Oblique inguinal hernia

Repair of the defect by sutures with herniotomy (better) or without herniotomy.

9

Hernioplasty in Modalities of Surgical treatment in Treatment of Oblique inguinal hernia

* Alternative name

* Principle

* Advantages

10

Alternative name of Hernioplasty in Modalities of Surgical treatment in Treatment of Oblique inguinal hernia

Lichntenstein repair ليخنشتاين

11

Principle of Hernioplasty in Modalities of Surgical treatment in Treatment of Oblique inguinal hernia

Repair with mesh

12

Advantages of Hernioplasty in Modalities of Surgical treatment in Treatment of Oblique inguinal hernia

Tension free repair )> no recurrence

13

Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

* Preoperative preparation :

* Operative

14

Preoperative preparation in Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

Treat first any predisposing factor as COPD, BPH

15

Operative in Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

* Anesthesia

* Position

* Sterilization

* Incision

* Steps

16

Anesthesia in Operative in Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

General / spinal or epidural / local anesthesia

17

Position in Operative in Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

Supine.

18

Sterilization in Operative in Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

Betadine from umbilicus to mid-thigh.

19

Incision in Operative in Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

1 inch above & parallel to the medial 2/3 of the inguinal ligament

20

Steps in Operative in Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

1. Divide skin, S.C tissue & Scarpa's fascia.

2. Divide the external oblique aponeurosis in the direction of its fibers

3. Reflect the ext oblique aponeurosis upwards & downwards.

4. Identify the ilioinguinal nerve & reflect it over the aponeurosis

5. The cord is delivered & lifted over a gauze tape.

6. Divide the cremasteric muscle & internal spermatic fascia

7. Manipulation of the sac

8. Herniotomy alone is enough in congenital hernia in infants and children

9. Herniorrhaphy

or

10. Hernioplasty

21

The direction of its fibers in Division of the external oblique aponeurosis in the direction of its fibers in Steps in Operative in Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

from the external ring extending laterally till the internal ring

22

Reflection of the external oblique aponeurosis upwards in Steps in Operative in Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

to expose the conjoint tendon

23

Reflection of the external oblique aponeurosis downwards in Steps in Operative in Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

to expose the superior surface of the inguinal ligament.

24

Identification of the ilioinguinal nerve & its reflection over the aponeurosis in Steps in Operative in Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

as injury of the ilioinguinal nerve at this level causes hypoesthesia in the scrotum only without any paralysis.

25

Manipulation of the sac in Steps in Operative in Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

1. Identification of The sac

2. Identification of The neck

3. Dissection of the sac by sharp & blunt dissection until its neck

4. Twisting of the sac and its transfixation

5. Excision of the redundant sac

26

Identification of The sac in Manipulation of the sac in Steps in Operative in Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

The sac is known by:

*Pearly white in colour.

* Antero-lateral to the vas.

27

Identification of The neck in Manipulation of the sac in Steps in Operative in Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

The neck is known by:

* Lateral to the inferior epigastric vessels

* The narrowest Part of the sac.

* Extra-peritoneal fat around it

28

Twisting of the sac and its transfixation in Manipulation of the sac in Steps in Operative in Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

* if the sac is not the Processus vaginalis

* if the sac is the Processus vaginalis

29

if the sac is not the Processus vaginalis in Twisting of the sac and its transfixation in Manipulation of the sac in Steps in Operative in Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

Transfixation at the deep ring

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if the sac is the Processus vaginalis in Twisting of the sac and its transfixation in Manipulation of the sac in Steps in Operative in Surgical details of Surgical treatment in Treatment of Oblique inguinal hernia

* Transfixation of the proximal part

* Eversion of the distal part as in hydrocele.