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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_972_Библиотеки_им_академика_М_И_Перельмана
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HERNIA SURGERY
Simplied

HERNIA SURGERY
Simplied
Sachin Kuber MS (General Surgeon)
Director (Panel Surgeon)
Oyster and Pearl Hospital, Pune, Maharashtra, India
Rajiv Gandhi Medical University, Karnataka, India
Sanjeevan Hospital, Pune, Maharashtra, India
Yashada Hospital, Pune, Maharashtra, India
®
JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD
New Delhi • London • Philadelphia • Panama

®
Jaypee Brothers Medical Publishers (P) Ltd.
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Email: jaypee@jaypeebrothers.com
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© 2013, Jaypee Brothers Medical Publishers
All rights reserved. No part of this book and DVD-ROM may be reproduced in any form or by any means without the prior permission
of the publisher.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
This book has been published in good faith that the contents provided by the author contained herein are original, and is intended for
educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the author specically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not
specically stated, all gures and tables are courtesy of the author. Where appropriate, the readers should consult with a specialist or
contact the manufacturer of the drug or device.
Hernia Surgery Simplied
First Edition: 2013
ISBN: 978-93-5025-949-8
Printed at

Dedicated to
My mother
Late Mrs Anjali Bhaskar Kuber
My father
Mr Bhaskar D Kuber
My better half
Dr (Mrs) Mugdha Sachin Kuber
My teacher
Dr Laxmikant Shah

PREFACE
It is my great pleasure to introduce to you, all readers another marvel from M/s Jaypee Brothers Medical Publishers
(P) Ltd, New Delhi, India, and me. The book Hernia Surgery Simplified is a totally new concept of book writing.
This is very vast and complicated subject and any book written on this subject can never be perfect. As medical
field is changing and evolving so fast, that to accomplish this information in a single book is too difficult to comply.
Here, we have come up with a short book explaining about the facts of hernia repair. The aim of the book is to
present the latest techniques of hernia surgery prevalent today. We have tried to cover this huge subject in short
but adequate manner. All the chapters contain new and relevant, useful techniques of various types of hernia
repair. All the obsolete techniques are eliminated from the book. Our book also lets readers to know about the
latest mesh products available in the market, to make them familiar.
Our outlook in writing the book is to make hernia surgery easy for learners, surgeons in a way that they will get the
ready and useful information on this subject. To prepare a book in a handy manner is difficult than writing a huge
book. We have compiled the latest techniques on hernia repair in the book. This will surely help the undergraduate
and postgraduate students to understand what is happening in the medical and surgical field today.
It is our sincere attempt to put this valuable information on hernia surgery for your approval. We hope that this
detailed book dedicated to hernia repair will be useful in updating the knowledge of the learners.
Sincerely, I thank M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for giving me an
opportunity to write the book.
Sachin Kuber

CONTENTS
1. MilestonesinHerniaSurgery 1
• History of the Procedure 3
2. SurgicalAnatomyofHerniaSites 5
• Surgical Anatomy of Hernia Sites 5
• External Anatomy of Abdominal Wall—e Surface Markings 6
• e Fascia 7
• Rectus Abdominis and Rectus Sheath 8
• Importance of Langer’s Lines in Hernia Surgery 16
• Vascular Supply of Abdomen 17
• Posterior Abdominal Wall 21
• Blood Supply of Posterior Abdominal Wall 22
• Deep Inguinal Ring 23
• Diaphragm 29
• Esophageal Hiatus 30
3. Incidence,PrevalenceofHernia 32
• Incidence, Prevalence of Hernias (Abdominal) 32
• Epidemiology 34
• Epigastric Hernia 34
• Hiatal Hernia 34
• Epidemiology of Inguinal Hernia Survey Results 35
4. EtiologyofHerniation 37
• Etiology 37
• Pathophysiology 39
5. ProsthesisUsedinHernioplasty 46
• Use of Prosthetics in Hernia Repair 46
• Permacol 49
• AlloDerm Mesh 49
• Flat Nonabsorbable/Partially Absorbable Mesh 50

x
Hernia Surgery Simplied
• Ultrapro (Poliglecaprone-25/Polypropylene) Synthetic Partially Absorbable Mesh 53
• Devices for Inguinal Hernioplasty 54
• Ultrapro* Plug 56
• Proceed* Surgical Mesh 57
• Proceed* Ventral Patch 58
• Preshaped Mesh Device for Inguinal Hernia 60
• Gore Dualmesh® Biomaterial 62
• Complications Related to the Use of Prosthetics 63
6. ClassicationofHernia 64
• Classication of Abdominal Hernia 64
• Endoscopic/Laparoscopic Classication of Hernia 65
7. DiagnosisofHernia 68
• Presentation of Hernia 68
• Other Hernias 69
• Diagnosis 69
• Presentation 70
• Dierential Diagnosis 70
• Symptoms 70
• Diagnosis 70
• Monolocular Properitoneal Hernia 71
• Dynamic Ultrasound Versus a CT or MRI Scan for Diagnosing Hernias 77
• Computed Tomography 78
• Magnetic Resonance Imaging 80
8. PrinciplesofHerniaRepair 81
• Current Guidelines in Hernia (Abdominal) Surgery 81
• Wound Healing in the Presence of Prosthetic Mesh 82
• Suturing Materials 82
• Placement of Prosthetic Mesh 82
9. AnesthesiainHerniaSurgery 83
• Anesthesia for Hernia Repairs 83
• Local Anesthesia for Hernias (Inguinal) 83
• Complications 86
• Toxicity of Local Anesthetic Agents 86

Contents
10. OpenAnteriorRepairofInguinalHerniainAdult 88
• Techniques of Open Anterior Inguinal Hernia Repair 88
• Details of Procedure 88
• Inguinal Dissection 90
• Reconstruction 91
• e Repair Technique (Other Way Around) 94
• Advantages and Disadvantages 97
• Technique 98
11. LaparoscopicInguinalHerniaRepairs 102
• Denitions 103
• Laparoscopic Inguinal Anatomy 104
• Indications 105
• Contraindications 107
• Anesthesia 107
• Positioning 108
• Technique TEP—Total Extraperitoneal Repair 108
• Important Tips 111
• Complications 111
• Transabdominal Preperitoneal Hernia Repair 112
• Final Word 119
xi
12. FemaleInguinalHernia 120
• Anatomy and Surgery Techniques 120
• Contents 120
• Female Inguinal Hernia 121
• Operative Technique 122
13. PediatricInguinalHernia 123
• Inguinal Hernia in Children 123
• Mortality/Morbidity 125
• Dierential Diagnoses of Inguinal Hernia in Children 126
• Hydrocele and Hernia in Children Varicocele in Adolescents 126
• Repair of the Pediatric Inguinal Hernia 128
14. FemoralHernia 133
• Surgery 133

xii
Hernia Surgery Simplied
• Anatomy 133
• Demographics 136
15. UmbilicalHernia 144
• Umbilical Hernias 144
• Diagnosis 144
• Treatment 145
• Epidemiology and Pathology 147
• Mayo’s Procedure for Umbilical Hernia 147
• Laparoscopic Repair 149
16. EpigastricHernia 150
• Epigastric Hernia 150
• Investigations 151
17. Incisional/VentralHernias 163
• Incisional/Ventral Hernia Surgery 163
• Demographics 163
• Diagnosis 164
• Treatment 167
• Open Prosthetic Incisional Hernia Repair 167
• Postoperative Complications 175
• Wound Complications/Fluid Collections 175
• Recurrence 176
18. LumbarHernia(TypesofLumbarHerniaSurgery) 177
• Hernia of the Superior Lumbar Triangle 177
• Lumbar Hernia: Diagnosis by CT 180
• Treatment 183
19. SpigelianHernia 185
• Denition 185
• Diagnosis 186
• Laparoscopic Surgery for Spigelian Hernia 188
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