Inguinal Hernia Repair Past,Present & Future

Posted by e-Medical PPT Monday, July 23, 2012
Anatomy OF the Inguinal Canal
4cm in length 2-4 cm cephalad to inguinal ligament Extends between superficial and deep rings Contains spermatic cord or round ligament Bounded superficially by external oblique Cephalad by internal oblique, TA, transversalis Inferior border is inguinal ligament Floor is transversalis fascia

Accounting for 75% of all abdominal wall hernias, and with a lifetime risk of 27% in men and 3% in women, inguinal hernia repair is one of the most commonly performed surgeries in the world
In the United States, inguinal herniorrhaphy accounts for approximately 800,000 cases yearly

Nyhus classification of groin hernias
Type I—Indirect inguinal hernia  Internal inguinal ring normal (ie, pediatric hernia)
Type II—Indirect inguinal hernia  Dilated internal inguinal ring with posterior inguinal wall intact
Type III—Posterior wall defects  Direct inguinal hernia  Indirect inguinal hernia: dilated internal ring with large medial encroachment on the transversalis fascia of the Hesselbach’s triangle (ie, massive scrotal, sliding hernia)  Femoral hernia
Type IV—Recurrent hernia

Era of Laparascopy
The laparoscopic transabdominal intraperitoneal onlay has gradually been replaced by the transabdominal preperitoneal mesh repair and totally extraperitoneal approach .
The success of these two techniques is based on fixation of prosthetic mesh to the classifically defined structures during open herniorrhaphy in the transversus abdominis aponeurotic arch, pubic tubercle, iliopectineal ligament, and iliopubic tract.
The initial limited understanding of the anatomic structures of the inguinal region, when viewed posteriorly, led to reports of nerve entrapment syndromes such as meralgia paresthetica

A comparative study of standard versus laparoendoscopic single-site surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair
Inguinal hernia repair via the LESS TEP technique is as safe as the standard TEP technique
Laparoendoscopic single-site surgery (LESS) is a laparoscopic surgery in which a single small incision is made, associated with the use of a special device (single-port), or several small incisions grouped in one location (single-incision) are made, through which the laparoscopic trocars are inserted
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