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Surgical Principles
inInguinal Hernia
Repair
A Comprehensive Guide
to Anatomy and Operative
Techniques
Melissa Phillips LaPinska
Jerey A. Blatnik
Editors
123

Surgical Principles in Inguinal
Hernia Repair

Melissa Phillips LaPinska
Jerey A. Blatnik
Editors
Surgical Principles in
Inguinal Hernia Repair
A Comprehensive Guide to Anatomy
and Operative Techniques

Editors
Melissa Phillips LaPinska
Department of Surgery
University of Tennessee Health Science
Center
Knoxville
TN, USA
Jeffrey A. Blatnik
Department of Surgery
Washington University Medical Center
Department of Surgery
St Louis
MO, USA
ISBN 978-3-319-92891-3 ISBN 978-3-319-92892-0 (eBook)
https://doi.org/10.1007/978-3-319-92892-0
Library of Congress Control Number: 2018954772
© Springer International Publishing AG, part of Springer Nature 2018
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specic statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, express or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

To our surgical mentors for helping us stand on the shoulders
of giants– especially Dr. Bruce Schirmer, Dr. Jeff Ponsky, and
Dr. Jeff Marks– and to our family for loving us as we share our
time with teaching others.

Preface
Inguinal hernia repair remains one of the most commonly performed operation in the United States and internationally. The multiple surgical procedures
that have been described to address this show the challenge that surgeons face
on a daily basis– that is, there is not a single “best” operation to suit a wide
variety of patients with signicantly different clinical scenarios. Currently,
texts have addressed the ventral and incisional hernias, but there has not been
a comprehensive guide to the management of the inguinal hernia, which represents a large number of surgical procedures performed. Surgical Principles
in Inguinal Hernia Repair has been written by many of the key leaders in
hernia surgery with the hopes of being able to share not only the latest literature but also the “tricks and tips” that really make up the details of these surgical procedures. It presents a curriculum for basic and common general surgery
procedures while detailing the complex scenarios in which one can encounter
an inguinal hernia such as in the setting of bowel injury or contamination or
in a patient needing prostatectomy. The technical details including online
access to surgical videos are discussed for many different scenarios. It is our
hope that this text will guide the reader to consider and learn to apply each of
these surgical techniques to optimize their individual patient as the center of
the surgical choice in management of the inguinal hernia. The text also
addresses important topics for the community and academic surgeon, such as
the training of residents in inguinal hernia and the importance in surgeon kept
outcome data. This book would not be possible without the help of each
author who has contributed his or her time and effort in the submission of the
individual chapters and the publishing team at Springer for their guidance
and direction in this project. Surgical Principles in Inguinal Hernia Repair
will be an invaluable resource to the practicing general and trauma surgeon
including residents and fellows in these areas. On behalf of my coeditor and
I, we hope you enjoy Surgical Principles in Inguinal Hernia Repair.
Knoxville, TN, USA MelissaPhillipsLaPinska
St Louis, MO, USA JeffreyA.Blatnik
vii

Contents
Part I Preoperative Evaluation
1 Preoperative Considerations andPatient Optimization . . . . . . 3
Amber Shada
2 Inguinal andFemoral Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . 7
John Mark McLain, Aaron Joseph Arroyave,
Matthew L. Mancini, and Melissa Phillips LaPinska
3 Inguinal Hernia Repair: Selecting aRepair . . . . . . . . . . . . . . . . 15
Sepehr Lalezari and Gina L. Adrales
4 Prosthetic Options: Advantages andDisadvantages . . . . . . . . . 25
Yuri W. Novitsky and Luis A. Martin-del-Campo
Part II Open Surgical Techniques
5 Open Non-mesh Inguinal Hernia Repair . . . . . . . . . . . . . . . . . . 33
Bruce Ramshaw and Sherard Chiu
6 Open Inguinal Hernia Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Wen Hui Tan and Jeffrey A. Blatnik
7 Preperitoneal (Stoppa) Open Inguinal Hernia Repair . . . . . . . 45
Arielle J. Perez and David M. Krpata
Part III Laparoscopic Repair Techniques
8 Transabdominal Preperitoneal (TAPP) Repair . . . . . . . . . . . . . 55
Vamsi V. Alli and Eric M. Pauli
9 Totally Extraperitoneal (TEP) Repair (with Video) . . . . . . . . . 67
David J. Berler and Brian P. Jacob
10 Robotic Inguinal Hernia: TheWhy andtheHows . . . . . . . . . . 73
Gregory J. Mancini and Dennis R. Van Dorp
ix

x
11 Laparoscopic Femoral Hernia Repair . . . . . . . . . . . . . . . . . . . . 81
Benjamin Carr and Dana Telem
12 Fixation inLaparoscopic Inguinal Hernia Repair . . . . . . . . . . . 85
Nathaniel Stoikes, David Webb, and Guy Voeller
Part IV Postoperative Management
13 Postoperative Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Steve R. Siegal and Sean B. Orenstein
14 Inguinodynia: Nonoperative Management . . . . . . . . . . . . . . . . . 99
Janavi Rao and Michael Bottros
15 Operative Management ofInguinodynia . . . . . . . . . . . . . . . . . . 109
Michael W. Robinson and David C. Chen
16 Surgical Outcomes: TheImportance
ofSurgeon-Kept Data inHernia Care . . . . . . . . . . . . . . . . . . . . 119
Nicholas H. Carter and Richard A. Pierce
Part V Special Situations in Inguinal Hernia Repair
17 Sports Hernia andAthletic Pubalgia . . . . . . . . . . . . . . . . . . . . . 127
Arghavan Salles and L. Michael Brunt
Contents
18 Inguinal Hernia Repair inChildren . . . . . . . . . . . . . . . . . . . . . . 139
Domenic R. Craner, Ian C. Glenn, and Todd A. Ponsky
19 Inguinal Hernia Repair intheSetting ofBowel
Injury/Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Garth R. Jacobsen and Jessica L. Reynolds
20 Inguinal Hernia Repair Around Prostatectomy . . . . . . . . . . . . . 153
Stephen Masnyj and Matthew I. Goldblatt
21 Recurrent Inguinal Hernia Repair . . . . . . . . . . . . . . . . . . . . . . . 159
Jared McAllister and Jeffrey A. Blatnik
22 Training General Surgery Residents inInguinal
Hernia Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Nicole Kissane Lee, Vandana Botta,
and Mariah Alexander Beasley
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

Contributors
Gina L. Adrales Department of Surgery, Johns Hopkins Hospital, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
Vamsi V. Alli Division of Minimally Invasive and Bariatric Surgery,
Department of Surgery, Penn State Hershey Medical Center, Hershey, PA,
USA
MariahAlexander Beasley University of Tennessee School of Medicine,
Department of Surgery, Knoxville, TN, USA
DavidJ.Berler Resident in General Surgery, Icahn School of Medicine at
Mount Sinai, New York, NY, USA
JeffreyA. Blatnik Section of Minimally Invasive Surgery, Department of
Surgery, Washington University School of Medicine, St. Louis, MO, USA
VandanaBotta University of Tennessee School of Medicine, Memphis, TN,
USA
Michael Bottros Department of Anesthesiology, Washington University
School of Medicine, St. Louis, MO, USA
BenjaminCarr Department of Surgery, University of Michigan, Ann Arbor,
MI, USA
NicholasH.Carter Department of Surgery, Vanderbilt University Medical
Center, Nashville, TN, USA
DavidC. Chen Lichtenstein Amid Hernia Clinic, David Geffen School of
Medicine at UCLA, Los Angeles, CA, USA
Sherard Chiu Department of Surgery, University of Tennessee Graduate
school of Medicine, Knoxville, TN, USA
Domenic R. Craner Akron Children’s Hospital, Department of Pediatric
Surgery, Akron, OH, USA
IanC.Glenn Akron Children’s Hospital, Department of Pediatric Surgery,
Akron, OH, USA
MatthewI.Goldblatt Medical College of Wisconsin, Milwaukee, WI, USA
BrianP. Jacob Icahn School of Medicine at Mount Sinai, New York, NY,
USA
xi

xii
Garth R. Jacobsen University of California San Diego, San Diego, CA,
USA
DavidM.Krpata Cleveland Clinic Comprehensive Hernia Center, Digestive
Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH,
USA
Sepehr Lalezari Johns Hopkins University Bayview Medical Center,
Baltimore, MD, USA
MelissaPhillipsLaPinska Department of Surgery, University of Tennessee
Medical Center, Knoxville, TN, USA
NicoleKissaneLee Indiana University School of Medicine, Department of
Surgery, Indianapolis, IN, USA
Gregory J. Mancini Department of Surgery, University of Tennessee,
Knoxville, TN, USA
Matthew L. Mancini Department of Surgery, University of Tennessee
Medical Center, Knoxville, TN, USA
Luis A. Martin-del-Campo Columbia University Medical Center, New
York, NY, USA
StephenMasnyj Medical College of Wisconsin, Milwaukee, WI, USA
Contributors
Jared McAllister Section of Minimally Invasive Surgery, Department of
Surgery, Washington University School of Medicine, St. Louis, MO, USA
John Mark McLain Department of Surgery, University of Tennessee
Medical Center, Knoxville, TN, USA
L. MichaelBrunt Department of Surgery and Section of Minimally Invasive
Surgery, Washington University School of Medicine, St. Louis, MO, USA
Yuri W. Novitsky Columbia University Medical Center, New York, NY,
USA
Sean B. Orenstein Oregon Health & Science University, Portland, OR,
USA
Eric M. Pauli Division of Minimally Invasive and Bariatric Surgery,
Department of Surgery, Penn State Hershey Medical Center, Hershey, PA,
USA
ArielleJ.Perez Cleveland Clinic Comprehensive Hernia Center, Digestive
Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH,
USA
RichardA. Pierce Department of Surgery, Vanderbilt University Medical
Center, Nashville, TN, USA
Todd A. Ponsky Akron Children’s Hospital, Department of Pediatric
Surgery, Akron, OH, USA
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