Surg Clin North Am. Dec;78(6) Inguinal hernia repair. The Nyhus posterior preperitoneal operation. Patiño JF(1), García-Herreros LG, Zundel N. A hernia is an outpouching of the parietal peritoneum through a preformed or secondarily established hiatus. If the hernia Table Ib. Nyhus hernia classification. Adapted with permission from Nyhus LM, Klein MS, Rogers FB. Inguinal hernia. Curr Probl Surg ;

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Surgical Options in the Management of Groin Hernias

First description was made by Arnaud de Villeneuve inbut it was not until that the term epigastric hernia was introduced by Leveille. Epigastric Hernia This type of hernia presents herniation into preformed defects of the linea alba nyhue xiphoid and umbilicus.

Obturator Hernia Obturator hernias are internal herniations through the obturator foramen, bordered by the obturator vessels and nerve.

While these syndromes are often self-limited, surgery has been necessary to remove the staples that caused the neuralgia. Obturator hernias are internal herniations through the obturator foramen, bordered by the obturator vessels and nerve. Diagnosing inguinal hernias in children can be very difficult.

Postoperative course after inguinal herniorrhaphy.

Inguinal hernia repair. The Nyhus posterior preperitoneal operation.

Most current techniques for laparoscopic herniorrhaphy also subject patients to the risks and cost of general anesthesia. Recurrent inguinal hernia treated by classical hernioplasty.

Bilateral hernias may also be addressed simultaneously, using either an open or a laparoscopic procedure. Reprints are not available from the authors. Total extraperitoneal laparoscopic repair.

Average of 3 years, with a range of 1 to 5 years. Today the surgeon has a great variety of different biomaterials to choose of Table III. The presence of a systematic collagen defect might explain the high coincidence with aortic aneurysm and the high incidence in patients with known collagen diseases.

Get free access to newly published articles. Surgical Procedures Since the first Bassini procedure at the end of the last century, many different operative techniques have been introduced, nnyhus recently laparoscopic procedures. Hernia recurrence following inguinal herniorrhaphy is usually caused by the breakdown of a repair performed with tension along the fascial suture lines. A comparative retrospective study of operated incisional hernias] Chirurg.


The Cooper ligament repair. This approach was abandoned because of the potential for small-bowel obstruction and fistulae development caused by the exposure of bowel to mesh. However, instead of suturing the fascial layers together to repair the hernia defect, the surgeon uses a prosthetic, nonabsorbable mesh. Umbilical hernias in adults are indirect herniations through the umbilical canal, and there have a high tendency to incarce-rate and strangulate and do not resolve spontaneously.

Minimal tension is used to bring tissues together.

Support Center Support Center. Due to high recurrence rates, tension-free hernia repair with mesh is becoming more common.

Surgical Options in the Management of Groin Hernias – – American Family Physician

The long-term impact of complications secondary to untreated herniation is not fully known. This anatomic landmark is bounded by the rectus abdominis muscle medially, the herina ligament inferiorly and the inferior epigastric vessels laterally. See My Options close Already a member or subscriber?

The hernial sac can then migrate down along the femoral vessels into the anterior thigh.

Today there ynhus approximately cases are reported in the literature. In one recent study, 5 more than 60 percent of blue collar workers and 90 percent of desk workers returned to work within 10 days after undergoing tension-free hernia repair with mesh. Each is also featured for pros and cons i.

Nyhus and Condon’s Hernia, 5th Edition

The spontaneous resolution appears to be directly influenced by the size of the umbilical ring. Depending of the position of the mesh-placement the sublay- inlay- and onlay technique are differentiated. Recurrence is the most common long-term complication of inguinal herniorrhaphy. Management involves operative therapy by crural, inguinal, or preperitoneal approach for direct fixation of the inguinal ligament to the fascia pectinea of the pubic bone.

Again, all are very well written and loaded with information regarding repair and management. Nyhus and Condon’s Hernia. Posterior repair iliopubic tract repair and Nyhus technique is performed by dividing the layers of the abdominal wall superior to the internal ring and entering the properitoneal space.


Early in the development of the technique, hernias were repaired by placing a large piece of mesh over the entire inguinal region on top of the peritoneum. While a broad consensus on the best classification system has not been achieved, the Nyhus classification system Table 1 4 is often referred to in the literature. In case of small hernias with a size of four or less centimeters an attempt to try nonabsorbable continuous sutures, if absorbable materials has been used before, can be undertaken.

Shouldice inguinal hernia repair in the male adult: While laparoscopic herniorrhaphy tends to offer greater protection to the ilioinguinal and iliohypogastric nerves, injuries to the femoral or the lateral femoral cutaneous nerves have been reported. Until now, a general classification system that includes all kinds of hernias is not available. The outcome of nonabsorbable mesh placed within the abdominal cavity: Want to use this article elsewhere? When they case symptoms, they are almost always incarcerated, usually on the right side and often combined with a femoral hernial.

Purchase access Subscribe to JN Learning for one year. Here, the herniation passes under the inguinal ligament through the lacuna vasorum medially of the v. The meshes are usually implanted in the sublay-technique, covered by muscle and fascia from one side, and peritoneum from the other side. Incarceration is common, especially in smaller hernias, but strangulation is unusual. This book is recommended for both the novice and the well-established general surgeon.

In the managed-care environment, elective herniorrhaphy is under increasing pressure. Instead, they are acquired by the development of tissue deficiencies of the transversus abdominis muscle, which makes up the floor of the inguinal canal.