HERNIA NYHUS PDF

Turkey, tel: , fax: moc. Abstract Background: The repair of recurrent inguinal hernias after prosthetic mesh repair is usually diffucult due to considerable technical challenge and complications. There is also a greater risk of developing further recurrence. The aim of this study was to investigate the outcome of preperitoneal repair open posterior approach for recurrent inguinal hernias after Lichtenstein tension-free hernioplasty. Methods: We performed a prospective clinical study in 44 patients having recurrent inguinal hernias the period Preperitoneal repair was performed on all patients who have had Lichtenstein tension-free hernioplasty previously.

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Turkey, tel: , fax: moc. Abstract Background: The repair of recurrent inguinal hernias after prosthetic mesh repair is usually diffucult due to considerable technical challenge and complications. There is also a greater risk of developing further recurrence. The aim of this study was to investigate the outcome of preperitoneal repair open posterior approach for recurrent inguinal hernias after Lichtenstein tension-free hernioplasty.

Methods: We performed a prospective clinical study in 44 patients having recurrent inguinal hernias the period Preperitoneal repair was performed on all patients who have had Lichtenstein tension-free hernioplasty previously. The age, gender, operating time, hospital stay, postoperative complication rates and recurrence rates of patients were evaluated.

Results: There were no serious intraoperative complications. There were 36 men and 9 women in the study, whose average age was The average operative time and hospital stay were Complications included 4.

Follow-up to date is months range, median 40 months. Conclusions: We concluded that the preperitoneal repair open posterior approach in recurrent inguinal hernias after Lichtenstein tension-free hernioplasty is a safe and efficient method with low complication and rerecurrence rates.

Since the introduction of the Bassini method in , more than 70 types of pure tissue repair have been reported in the surgical literature. The mot effective method to repair an inguinal hernia in any given patient is not clearly defined. Recently developed tensionfree methods have been found to be superior to conventional tension-producing techniques. An unacceptable recurrence rate and prolonged postoperative pain and recovery time after tissue repair along with our understanding of the metabolic origin of inguinal hernias led to the concept of tension-free hernioplasty with mesh 2.

The Lichtenstein tension-free hernioplasty began in and evolved between and to a procedure that is now considered the gold standard of hernia repair by the American College of Surgeons 3. It is widely accepted and used even in recurrent cases with very low recurrence rates 4. Altough it is very rare, the repair of recurrent inguinal hernia after Lichtenstein hernioplasty is usually a dif?

However, a preperitoneal posterior approach, open or laparoscopic, reduces these problems. Laparoscopic preperitoneal hernia repair is documented as an excellent choice for inguinal hernia repair in numerous studies with its low hospital stay, postoperative pain and recurrence rates, especially when the surgeon is experienced 5. The costs and long learning curve are the two major disadvantages of laparoscopic approach. The open posterior preperitoneal mesh repair popularized by Nhyus is still a good alternative for recurrent inguinal hernias 6.

The main advantages of the preperitoneal approach are mesh placement in the preperitoneal space where the hernia is produced and avoiding the disadvantage of reoperating through scar tissue 7.

The objective of this article is to investigate the outcome of preperitoneal repair open posterior approach for recurrent inguinal hernias after Lichtenstein tension-free hernioplasty. Patients and Methods We performed a prospective clinical study in 44 patients between Patients operated previously via methods other than Lichtenstein hernioplasty were excluded.

This study was approved by local ethic committee and informed consent was taken from patients. Preperitoneal repair was performed by the same surgical team on 44 patients with recurrent inguinal hernias who have had Lichtenstein tension-free hernioplasty previously. Intraoperative data were recorded at the time of operation, including size of mesh and Nyhus classification of the hernia.

Immediate postoperative within two weeks and early postoperative within 2 months complications of herniorrhaphy were recorded at routine visits. Patients were contacted four to five times by routine physical examination. Patients were assessed yearly for recurrence. Surgical technique Cefazolin 1 gr IV was employed in antibiotic prophylaxis. Following general or regional anesthesia, open preperitoneal mesh repair posterior approach was undertaken.

Through a lower abdominal transverse incision, the anterior rectus sheath was incised and the muscle re? The preperitoneal space was cleaved with blunt dissection, exposing the myopectineal ori? The cord was explored and the hernias were reduced. A 10x15 cm polypropylene mesh with a slit was inserted in the preperitoneal space and? The mesh was passed behind the cord and manipulated to lay flat against the posterior inguinal floor overlapping the entire myopectineal orifice.

No drains were used.

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HERNIAS NYHUS PDF

While some surgeons believe that broad-based direct hernias do not need to be repaired, the uncertainty of determining the status of a hernia preoperatively argues against this practice. Almost all groin hernias should be surgically repaired. The development of femoral herniation is hernjas well understood. The Cologne Hernia Study Group. The presence of incarceration or strangulation usually mandates urgent operative repair. The major nerves in the inguinal region are the ilioinguinal, iliohypogastric and genitofemoral nerves. The figures are well crafted, and the color plates are excellent.

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