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22 Training General Surgery Residents inInguinal Hernia Repair
171
Acknowledgments The authors would like to thank
Hobart Akin, MD, FACS, Sperry Nelson, MD, FACS, and
the staff at the University of Tennessee Center for
Advanced Medical Simulation for their invaluable contributions to this hernia curriculum.
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14. Niitsu H, Hirabayashi N, Yoshimitsu M, etal. Using
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15. Polavarapu HV, Kulaylat AN, Sun S, Hamed OH.
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future. Bull Am Coll Surg. 2013;98(7):22–7.
16. Rochlen LR, et al. First-person point-of-viewaugmented reality for central line insertion training.
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17. Rutkow IM.Demographic and socioeconomic aspects
of hernia repair in the United States in 2003. Surg Clin
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18. Sharma G, Aycart MA, Najjar PA, van Houten T,
Smink DS, Askari R, etal. A cadaveric procedural
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20. Wilkiemeyer M, Pappas TN, Giobbie-Hurder A, Itani
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Index
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
A
Abdominal core injury, 127
Abdominal wall, fascial layers of, 9
Adductor tenotomy, 134, 135
Adhesiolysis, 60
American College of Surgeons National Surgical Quality
Improvement Database (ACS NSQIP), 122
Americas Hernia Society Quality Collaborative
(AHSQC), 122
Anterior inguinal neurectomy, 114
Aponeurosis, 167
Athletic pubalgia, see Sports-related groin injuries
Atraumatic mesh xation, 28
B
Bassini repair, 15, 34, 168
Bilateral Cooper’s ligaments, 49
Bilateral inguinal hernias, 19
port placement diagram for, 58
Bowel injury/resection
clean-contaminated wound, 149, 150
contaminated wound, 150
dirty wounds, 150, 151
C
Camper’s and Scarpa’s fasciae, 167
Children, hernia
diagnosis, 140
epidemiology, 139
evidence-based proposals, 144
expectant vs. surgical management, 140
extraperitoneal repair, 141–143
incarceration/strangulation
bowel perforation, 144
clinical presentation, 144
manual reduction of hernia, 144, 145
open and laparoscopic repairs, 145
recurrence, 145
scar tissue, 145
surgical management, 144
surgical treatment, 144
intraperitoneal repair methods, 140, 141
laparoscopic repair, 140
open herniorrhaphy, 140
pathophysiology, 139
patient positioning, 141
peritoneum, 142
surgical approach for repair, 143
Chronic postherniorrhaphy inguinal pain, 109
See also Inguinodynia
Chronic preoperative narcotics, 94
Clean-contaminated wound, 149, 150
Clinical curriculum, 165
Contaminated wound, 150
Cooper’s ligament, 9, 10, 36, 69
Cord lipoma management, 63, 64
Corona mortis vessels, 62
D
Data collection, hernia outcomes, 121
da Vinci Xi system, 74, 78
Desarda repair, 35
Diabetes, 5
Dirty wounds, 150, 151
E
Endoscopic retroperitoneal exposure
with genitofemoral nerve trunk, 114
with iliohypogastric and ilioinguinal nerve trunks,
114
Epigastric vessels, 10
EuraHS, 122
Expanded polytetrauoroethylene (ePTFE), 25
External oblique aponeurosis, closure of, 42
F
Femoral hernia (FH), 11, 81
management strategy and operative technique,
82, 83
Femoroacetabular impingement (FAI), 129
Fluid management, 92
© Springer International Publishing AG, part of Springer Nature 2018
M. P. LaPinska, J. A. Blatnik (eds.), Surgical Principles in Inguinal Hernia Repair,
https://doi.org/10.1007/978-3-319-92892-0
173
174
Index
G
Genitofemoral nerve (GFN), 12, 99, 100, 111, 112
trunk, 114
Giant scrotal hernias, 20
Gilmore’s groin, 127
Gonadal vessels, 11
Groin, 25
hernias, 82
muscular anatomy of, 8–10
nerves in, 11, 12
pain, 101, 106
vascular anatomy of, 10, 11
Guarnieri technique, 35, 36
H
Hasson trocar, 69, 77
Healthcare nancing environment, 121
Hematoma, 96
Herniamed, 122
Hernia recurrence, 97
Hockey groin syndrome, 127
I
Iliohypogastric nerve (IHN), 11, 12, 99, 100, 106, 110,
114, 115, 167
Ilioinguinal nerve (IIN), 11, 12, 40, 99, 100, 102, 106,
112, 114
Iliopsoas muscle, 49
Incarcerated inguinal hernias, 19, 20, 144, 145
Inferior epigastric vessels, 61, 69
Inammatory nociceptive pain, 101
Inguinal canal
anterior and posterior fascial fusion of, 8
nerves of, 12
Inguinal disruption, 127
Inguinal hernia, 25–29
prosthetics used for
biologic mesh, 27
synthetic, 25–27
synthetic mesh selection
composite mesh, 28
IPOM, 28, 29
minimally invasive repairs, lightweight/
heavyweight mesh in, 28
open surgery, lightweight/heavyweight mesh in,
27, 28
self-gripping and preformed mesh, 28
Inguinal hernia repair, 7–12, 15–21
classication, 7
diabetes, 5
groin
muscular anatomy of, 8–10
nerves in, 11, 12
vascular anatomy of, 10, 11
hernia factors
bilateral, 19
giant scrotal, 20
multiply recurrent hernias, 19
recurrent hernias, 18
scrotal and incarcerated, 19, 20
mesh selection process for, 26
MRSA, 5
nutrition, 5
obesity, 4
patient factors
anesthesia considerations, 17
economic considerations, 17, 18
female, 16–17
men, 17
wound classication, 18
preoperative risk factors, 3–4
primary/tissue, 15
randomized studies, 3
surgeon factors
experience level, 21
preferences, 20–21
surgical technique, 5, 7
TAPP and TEP, 16
tension-free mesh repair, 16
tobacco use, 4
in USA, 3
Inguinodynia, 97
acupuncture, 103
anticonvulsants, 105
antidepressants, 105
botulinum toxin A, 105
capsaicin, 105
classication, 102
diagnosis, 103
drugs and opioids, 104
incidence, 99
interventional pain management, 105
intraoperative damage, 100
lidocaine patches, 105
massages and stretching, 103
neuroablation, 106
neuromodulation techniques, 106, 107
neuropathic pain, 104
nociceptive pain, 105
non-pharmacological modalities, 103
operative risk factors, 102
opioid medications, 105
persistent postsurgical pain, 99, 102
pharmacological modalities, 104
physiotherapy, 103
postoperative morbidity, 109
postoperative risk factors, 102
preoperative risk factors, 101
symptoms, 102
ultrasound/uoroscopy-guided nerve blocks, 105
Intraperitoneal onlay mesh (IPOM), 28, 29
repair, 66
Intravenous crystalloid infusions, 92
L
Laparoscopic inguinal hernia repair (LIHR)
after prostatectomy, 157
Index
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175
before radical retropubic prostatectomy, 154, 155
children, 140–143
and open radical prostatectomy, 156, 157
prophylactic procedures, 157
Laparoscopic inversion ligation, children, 141
Laparoscopic preperitoneal hernia repair, 153
adhesive and alternative xation, 87
xation, biomechanics of, 87, 88
mechanical xation, 86
mesh, xation of, 85
no xation, 85
Laparoscopic preperitoneal paravasal neurectomy, 114,
116
Laparoscopic repair, 67, 68, 71
Laparoscopic retroperitoneal triple neurectomy, 114
Lateral femoral cutaneous nerve (LFN), 99, 100, 114
Lichtenstein approach, 150
Lichtenstein mesh hernioplasty, 101
Lichtenstein repair, 39–42, 159, 160
of inguinal hernia, 94
Linea semilunaris, 58
M
Maryland grasper, 62
McVay/Cooper’s repair, 35, 168, 169
Medical Device Regulation Act, 38
Medical simulation, 169
Mesh-related pain and meshoma, 115
Methicillin-resistant Staphylococcus aureus (MRSA), 5
Mild postoperative nausea, 92
Minimally invasive inguinal hernia, 73
lightweight/heavyweight mesh, 28
Minimally invasive surgery, 67
Modern plastic polymer technology, 38
Myopectineal orice (MPO), 45, 46, 55
critical view, 64
Open anterior paravasal neurectomy, 116
Open extended anterior neurectomy, 114
Open extended triple neurectomy, 113
Open inguinal hernia repair, 39–42
outcomes, 43
postoperative care, 42
preprocedure
Lichtenstein repair, 39–42
plug-and-patch system, 42
tissue-based repairs, 39
Open non-mesh inguinal hernia repair, 34–36
general principles, 36
inguinal anatomy, complexity of, 33, 34
outcomes, 36, 37
techniques
Bassini repair, 34
Desarda repair, 35
Guarnieri, 35, 36
McVay/Cooper’s repair, 35
Shouldice repair, 34, 35
Open preperitoneal mesh repair (OPMR), 159
Open prostatectomy after LIHR, 154
Open surgery, lightweight/heavyweight mesh, 27, 28
Open transinguinal repair, 110
Open triple neurectomy, 112
Operative management, inguinodynia
conservative measures, 110, 111
diagnostic evaluation, 109
hernia recurrence, 110
neuropathic pain, 110
nociceptive pain, 109
remedial surgery, 111
selective neurolysis/neurectomy, 111
visceral pain, 109
Opioid-induced constipation (OIC), 95
Orchialgia, 116
P
N
Neurectomy, 115
of autonomic nerves, 110
Neuroanatomy of inguinal region, 110
Neurolysis, 111
Neuropathic pain, 100
central sensitization, 101
ectopic activity, 100
peripheral sensitization, 101
Nociceptive pain, 101
Non-mesh Bassini repair, 168
Non-mesh herniorrhaphy, 169
Non-neuropathic pain, 103
Nutrition, 5
Pain management, 93
Patent processus vaginalis, 139–141
Patient-reported outcomes (PROs), 120–121
Pelvic lymphadenectomy, 155
Percutaneous inguinal ring suturing (PIRS)
technique, 141
Periostitis pubis, 101, 103
Peritoneoscopy, 59
Permanent synthetic mesh, 149
Persistent postherniorrhaphy pain, 103
Plant-based bioplastics, 38
Plug-and-patch system, 42
Pneumoperitoneum, 66
Polyester (POL), 25, 27
Polypropylene mesh, 25–27
Postanesthesia care unit (PACU), 91
O
Obesity, 4
Objective Structured Assessment of Technical Skills
(OSATS) criteria, 169, 170
Open anterior mesh removal and neurectomy, 113
Post-anesthesia phase II of care, 93
Posterior mesh repair for recurrent hernia, 162
Posterior open preperitoneal repair, 111
Postherniorrhaphy groin pain, 117
Postherniorrhaphy inguinodynia, 116
176
Index
Post-herniorrhaphy orchialgia, 116
Post-herniorrhaphy pain, 103
See also Inguinodynia
Postoperative activity and weight lifting restriction, 94
Postoperative inguinodynia, 109
Postoperative management
in adults, 94
anticoagulation, 95
antiplatelet therapy, 95
early mobilization and ambulation, 94
hematoma, 96
long term complications, 97
NSAIDs, 91
regular diet, 95
seromas, 96
short term complications, 96, 97
spermatic cord and testicular complications, 96, 97
wound infections, 96
wound/trocar site healing, 95
Postoperative nausea with vomiting (PONV), 92
Postoperative pain, 91
Postoperative recovery and home care after inguinal
hernia surgery, 93
Postoperative urinary retention (POUR), 92, 93
Premarket approval (PMA), 38
Preperitoneal inguinal hernia repairs, 113, 154
history, 45
pitfalls, 50
postoperative management, 50
preoperative considerations, 45, 47
prosthesis insertion, 50
technique, 47–49
Preperitoneal space, 50
Primary inguinal hernia, algorithm, management of, 21
Prolene hernia system, 42
Prosthetics, 25
Proximal iliohypogastric neurectomy, 115
Proximal neurectomy, 115
R
Radical prostatectomy (RP), 153
after LIHR, 156
Rectus abdominis bers, 69
Recurrent inguinal hernia, 159
CT scan, 161
in direct/indirect space, 160
heavy lifting and physical activity, 160
indications, 161
infected mesh, 161
magnetic resonance imaging, 161
open groin plug, 162
open preperitoneal mesh repair, 162
optimal type of repair, 161, 162
patient evaluation, 161
risk factors, 160
sigmoid colon involvement, 162
symptomatology, 161
TAPP procedure, 162
ultrasound, 161
Retromuscular ap, 48
Retroperitoneal and preperitoneal nerves, 113
Robot-assisted radical prostatectomy (RARP), 154, 155
Robotic-assisted inguinal hernia, 76, 77
adaptations
instruments, 77
patient positioning, 76
trocar placement, 76
cost-containment strategy, 75
patient selection, 75
published data, 74
robotic efciency and troubleshooting, 77, 78
Si versus Xi platform issues, 78
TAPP foundation, 75, 76
Robotic transabdominal preperitoneal mesh
removal, 116
S
SCORE curriculum, 166
Scrotal inguinal hernias, 19, 20
CT scan, 19
laparoscopic transabdominal preperitoneal repair, 20
Seroma, 96
Shouldice repair technique, 34–36
Somatic nociceptive pain, 101
Spermatic cord and testicular complications, 96, 97
Sports hernia, see Sports-related groin injuries
Sportsman’s groin, 127
Sports-related groin injuries, 127, 130, 131, 133, 134
abdominal wall repair, 131
genital neurectomy, 133
primary suture repairs, 133
tension-free mesh repair, 133, 134
adductor tenotomy, 134, 135
anatomy, 129
clinical evaluation
exion/abduction/external rotation, 130
exion/adduction/internal rotation, 130
history, 130
nonsteroidal anti-inammatory drugs, 131
physical examination, 130
diagnosis, 130
differential diagnosis, 129
dynamic ultrasound, 131
functional strengthening and core stabilization
exercises, 135
MRI, 131
open repair of inguinal oor, 133
partial adductor longus release, 135
pathophysiology, 128
pelvic MRI, 128
physical therapy, 131
plain x-rays, 131
rehabilitation after surgery, 135
strain placement, pubis, 128
Stimulus-independent paresthesias, 100
Stoppa repair, 47
Surgical resident education, 165, 166, 169
Surgical training programs, 166
Index
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177
cadaveric wet lab, 166
primary modalities, 166
Suture-based mesh xation, 28
T
TAPP repair, room setup for, 57
Tension-free mesh repair, 16, 25
Testicular artery, 11
Tinel’s test, 103
Tobacco use, 4
Total extraperitoneal (TEP) repair, 16, 45, 55, 67, 73, 159
complications and common pitfalls, 71, 72
historical perspective, 67, 68
indications and contraindications, 68
vs. TAPP vs. open repair, 68, 69
technique, 69, 70
Transabdominal preperitoneal (TAPP) repair, 16, 45,
55–58, 60–66, 73, 159
case completion, 66
ergonomic and operative ow considerations, 58, 59
operative technique
anesthesia, 56
patient preparation and positioning, 56, 57
port placement, 57, 58
post-procedure care, 66
procedure steps, 59, 60
cord lipoma management, 63, 64
lateral dissection, 62, 63
medial dissection, 62
mesh placement, 64, 65
middle dissection and sac reduction, 63
MPO, critical view, 64
peritoneal ap, closure of, 65, 66
peritoneal ap creation, 60, 61
robotic-assisted inguinal hernia, 75
technical disadvantage, 56
Transcutaneous electrical nerve stimulation (TENS), 103
Transversus abdominis, 8
Transversus abdominis release (TAR) method, 55
Triangle of doom, 11
Triangle of pain, 11
Triple neurectomy, 111, 112
U
Urologic consultation, 93
V
Vas deferens (paravasal nerves) injury, 11, 97, 110
Veteran Affairs Surgical Quality Improvement Database
(VASQIP), 122
Veterans Affairs system, 120
Virtual reality (VR) simulators, 169
Visceral nociceptive pain, 101
W
Wound classication, 18
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