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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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. Today, there is a great variety of surgical procedures available for the repair of inguinal hernia. Classification systems for groin hernias range from simple schemes to more complex systems with up to 20 categories. This material gernia not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.
Nyhus and Condon’s Hernia
Defects of the fascia may vary in diameter from several centimeters to only a few millimeters. A clear understanding of the epidemiology and anatomy of inguinal hernias provides a solid foundation for timely diagnosis and care. The development of femoral herniation is not well understood. Demographic, classificatory and socioeconomic aspects of hernia repair in the United States. Most inguinal hernia repairs can be performed safely, accurately and cost-effectively using local anesthesia and an open anterior approach.
In case of properly performed primary operation that means usually the reinforcement with alloplastic material, in regard to no mesh-free alternative. Continue reading from January 1, Previous: Incarceration is common, especially in smaller hernias, but strangulation is unusual. The presence of incarceration or strangulation usually mandates urgent operative repair.
Nyhus and Condon’s Hernia. In some series, the laparoscopic approach has been 40 percent more costly than other approaches. In some series, the recurrence rate following repair of a recurrent hernia is as high as 30 percent, which is significantly greater than the recurrence rate after initial repairs.
Earn up to 6 CME credits per issue. The recurrence rate following this relatively new technique cannot as be completely assessed, but it has been reported to be less than 4 percent. An additional 20 percent of recurrences may not present for 15 to 25 years. Based on their formation, we distinguish between congenital e. In the United States, approximately 96 percent of groin hernias are inguinal and 4 percent are femoral.
The use of fascia grafts to close large hernial orifices and recurrent hernias dates back to HalstedKirschnerRehnand Koontz Total extraperitoneal laparoscopic repair. The most common hernia in both sexes is the indirect inguinal hernia. Create a free personal account to download free article PDFs, sign up for alerts, and more.
If the hernia extends beyond the abdominal cavity and is thus visible on the surface of the body, it is defined as an external hernia. The anatomy of the inguinal region and its relation to groin hernia. Either general or regional spinal anesthesia may be used in these patients. In case of uncertain clinical findings, sonography is the best means for confirming the hernial opening and content.
Radiographic diagnosis of hernias is rarely required. Direct inguinal hernias are not generally congenital. Table Ia Aachen hernia classification. This breakdown may occur because of incomplete dissection, poor tissue quality longstanding large hernias or the patient’s too-rapid return to daily activities. Based on their pore size, he grouped the most frequently-used materials in hernia surgery into 4 types:.
Each jyhus has its own advantages and complications.
Since hernis herniorrhaphy can be performed using a variety of techniques, the approach can be individualized. J Am Coll Surg. If one system is universally used to classify hernias, surgeons will be able to perform individualized procedures for specific anatomic defects based on sound outcome data.
Nyhus and Condon’s Hernia | JAMA Surgery | JAMA Network
In recent studies, a defect in collagen metabolism could be proven as well, indicating the key role of the development of a mechanically strong scar tissue.
Dilated internal inguinal ring with posterior inguinal wall intact.
Here, the herniation passes under the inguinal ligament through the lacuna vasorum medially of the v. The tables are useable and nyhhus references are relevant.
This is the nerve most commonly injured during open herniorrhaphy. The techniques in the open anterior repair group differ somewhat in their approach to reconstruction, but henria all use permanent sutures to approximate the surrounding fascia and repair the floor of the inguinal canal. In most reports, the recurrence rate varies from 5 to 8 percent for indirect hernias and is slightly higher for direct hernias.
It is probably best performed with the patient receiving regional or general anesthesia.