INGUINAL HERNIA Fig. 24.10
Indirect Hernia
Fig 24.10a
Ingural incision half an inch above and paratel to the
inguinal ligament
Inguinal Hernia
Cut skin and subcutaneous tissue
Open external oblique aponeurosis in the same line
Identify the cord and free it by blunt dissection.
Open the cremaster muscle the indirect sac is identified and
opened finger introduced to enter the neck and peritoneal cavity.
Sac separated from cord structure by blunt and sharp
dissection
The contents reduced sac twisted and ligated as high as
possible. Sac excised.
Repair defect in transverselis fashia
If the posterior wall is weak a Bassini repair of the
posterior wall is done by plication
The conjoint tendon can also be sutured to the inguinal
ligament
External oblique is closed
DIRECT INGUINAL HERNIA
This
hernia is due to a diffuse bulge of the posterior wall
of
the
inguinal canal and it is this wall that needs repair
and
reinforcement with mesh after the sac
has been excised.
Direct Hernia
The incision is the same as for indirect hernia
The incision is depended to cut subcutaneous tissue
External oblique identified and cut along the line of
incision
The inguinal canal is now open
Identify the cord and free it by blunt dissection
The direct hernia bulge will be seen behind find the cord
Placation of the tranversalis muscle ligament
A Bassini repair of the posterior wall
Conjoint tendon is sutured to the inguinal ligament
In some cases a marlex mesh is sutured behind the cord to
reinforce the posterior wall
The external oblique and skin are closed.
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