inguinal hernia

Types of operations for inguinal hernia
-the goal of all hernia repairs is to eliminate the peritoneal sac (in the case of indirect hernia) and to close the fascial defect in the inguinal floor.
A. Simple high ligation of the sac through an inguinal incision is the key to the repair of indirect hernias in infans and children.
B. Macy repair is combined with a tightening of internal ring.
C. Open Mesh hernia repair
D. Laparoskopik technique, less pain and more rapid return to work, but expensive.
E. Bassini repair, the tradisional autologous tissue repairs. This is conjoined tendon is approximated to pouparts ligament and the spermatic cord remains in its normal anatomic position under the external oblique aponeurosis.
F. Halsted repair, external oblique beneath the cord but otherwise resembles the bassini repair.
G. Lotheissen-mcvay repair, bringing the conjoined tendon farther posteriorly and inferiorly to coopers ligament. Its effective for femoral hernia but always requires a relaxing incision to relieve tension
H. Shouldice repair, more extensive dissection required. The transversalis fascia is first divided and then imbricated to pouparts ligament. Finally, the conjoined tendon and internal oblique muscle are also approximated in layers to the inguinal ligament.

NON SURGICAL MANAGEMENT
Truss, should be fitted to provide adequate external compression over the defect in the abdominal wall. It should be taken off at night and put on in the morning before the patient arises. Its may cause fibrosis of anatomic structure so that subsequent repair may be more difficult.

Prognosis
- recurrence may be triggered by chronic cough, prostatism, constipation, poor tissue quality,infection and poor operative technique.