Indications
- Symptomatic herniae
- Irreducible herniae
- Patent processus vaginalis
Landmarks:
Inguinal Ligament (Gimbernaut):
- Formed from reflection of the aponeurosis of the external oblique muscle
- Runs from the Anterior Superial Iliac Spine (ASIS) to the pubic tubercle
Deep Ring: Midpoint of inguinal ligament
Superficial Ring: Above pubic tubercle
Ilioinguinal nerve
Position: Prone
Procedure
- Incise skin 2cm above inguinal ligament from deep ring to superficial ring
- Pass through superficial fascia/fat (Camper's)
- Pass through deep fascia (Scarpa's)
- Expose extern oblique apneurosis
- Enter inguinal canal, identify and protect ilioinguinal nerve
- Identify and protect the spermatic cord
- Dissect hernia sac (anterior + superior to cord)
- Open sac, inspect contents (may contain ovary in female), reduce hernia, close defect
- If bowel present, check viability (wrap in warm saline-soaked abdominal pack)
- If necrotic, must be resected
- Reinforce wall with mesh
- In children, repair is usually satisfactory, and don't need mes
- Tension-free repair: Liechtenstein (lateralises cord)
- Bassini repair
- Shouldice repair
- Ensure haemostasis, ensure testis in scrotum.