6. INVESTIGATIONSINVESTIGATIONS
HERNIOGRAPHY
Suspected hernia, but clinical diagnosis unclear
Procedure done under flouroscopy following injection
of contrast medium
Frontal and oblique radiographs are taken with and
without increased intra-abdominal pressure
19. HERNIOTOMYHERNIOTOMY
Opening up the inguinal canal
Separation of sac from cord structures
Reducing the content
Transfixation and high ligation of sac
Excision of sac
25. Father of Modern InguinalFather of Modern Inguinal
Hernia Repair - 1884Hernia Repair - 1884
EDUARDO BASSINI
26. BASSINI’S REPAIR
Opening the fasciatransversalis from pubic
tubercle to deep ring
Approximation with interrupted stitches of
silk
Approximation of conjoint tendon & upper
leaf of fasciatransversalis with inguinal
ligament & lower leaf of
fasciatransversalis
27. MODIFIED BASSINI
Not done nowadays
Fasciatransversalis is not opened
Approximation with continuous
interlocking stitch with prolene
Approximation of conjoint tendon with
inguinal ligament
28. SHOULDICE TECHNIQUE
Additional strength is given to the
posterior wall by “DOUBLE BREASTING”
the fasciatransversalis
Best among all anatomical repairs
(Herniorrhaphy)
Least recurrence
31. LICHTENSTEIN’S TENSION FREE
HERNIOPLASTY
Prolene mesh 16 X 10 cm size is taken &
fixed in the inguinal ligament
First bite periosteum of pubic tubercle
& fix the mesh to a point beyond the deep
ring
Fix the mesh with inguinal ligament &
conjoint tendon using 1’0 or 2’0 prolene
without tension
34. Laparoscopic mesh repairLaparoscopic mesh repair
Inlay mesh – approach through the
abdomen , mesh kept preperitoneally
Onlay mesh – mesh kept in the inguinal
canal in front of deep ring
40. Lap Hernia ComplicationsLap Hernia Complications
Vascular Injuries
Visceral Injuries
Trocar Site Complications
Bowel Obstructions
Hypercarbia syndrome
Abdomen Compartment Syndrome
41. PREVENTIONPREVENTION
You can't prevent the congenital defect
that may lead to an inguinal hernia, but
the following steps can help reduce strain
on your abdominal muscles and tissues
Hernia anatomy was not well understood, lack of understanding of the anatomy involved
or with healing allowed by secondary intention were the most common operations.
Bassini revolutionized the surgical repair of the groin hernia with his novel anatomical dissection and low recurrence rates – first operation in 1884