Surgical Repair of Indirect Inguinal Hernia

Surgical Repair of Indirect Inguinal Hernia

External Oblique Aponeurosis

External Oblique Aponeurosis Opened

Inguial Ligament

Conjoint Tendon



Inferior Epigastric Vessels



Indirect Sac Protruding out within the Spermatic Cord

Indirect Sac Opened

After Mesh Placement

Hernia is a Latin word which means a  tear or rupture.

Hernia is defined as protrusion of viscous in a part or whole through an abnormal opening in the walls of its containing cavity.

Inguinal Hernias Form 75% of the total abdominal wall hernias.

Anaesthesia

o Depends on personal  preference of surgeon.

o Laparoscopic Herniorrhaphy-G.A mandated by the pneumoperitonium.

o Otherwise G.A,epidural,spinal ,local or regional anaesthesia can be used.

Position of the patient – Supine

Incision-Oblique  incision 1.25 cm above and parallel to the inguinal ligament covering the medial two third. Inguinal ligament is attached to Anterior superior iliac spine to Pubic Tubercle.

Steps of Surgery

Step 1. External Oblique Aponeurosis  is defined -The First Landmark

Step 2. External Oblique Aponeurosis  is opened along the direction of its fibers and Inguinal Ligament and Conjoint Tendon are defined.

Step 3. Spermatic cord is hooked out from the medial end and is defined up to the deep ring where the inferior epigastric vessels are found.

Step 4. Spermatic cord  opened and Hernial Sac dissected out. In indirect hernia, the sac is found inside the spermatic sord.

Step 5. Indirect hernia sac is opened laterally, to prevent injury to the contents of the hernia sac like Urinary bladder.

Step 6. Herniotomy and  trans fixation of the sac is done at the level of the deep inguinal ring.

Step 7. Poly propylene  mesh is placed in the plane of conjoint tendon and the inguinal ligament

Step 8. Spermatic Cord is placed over the Mesh .

Step 9. External Oblique Aponeurosis is closed

Step 10. Skin and subcutaneous layer closure