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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1433_Библиотеки_им_академика_М_И_Перельмана.pdf
Fabio Amatucci CERGAS, Centre for Research on Health and Social Care
Management, Università Bocconi, Milan, Italy
Parviz K. Amid Lichtenstein-Amid Hernia Clinic, David Geffen School of
Medicine at the University of California, Los Angeles, Santa Monica, California,
USA
Kristoffer Andresen Department of Surgery, Herlev Hospital, Herlev, Denmark
Rafael Azuaje Hernia Institute of Florida, Miami, Florida, USA
Conrad D. Ballecer Center for Minimally Invasive and Robotic Surgery, Peoria,
Arizona, USA
Frederik Christiaan Berrevoet Department of General and
Hepatopancreaticobiliairy Surgery and Liver Transplantation, Ghent University
Hospital, Ghent, Belgium
Waqar Bhatti Hip and Groin Clinic, Spire Manchester Hospital, Manchester,
United Kingdom
Piero Giovanni Bruni General and Day Surgery Unit, Center of Research
and High Specialization for the Pathologies of Abdominal Wall and Surgical
Treatment and Repair of Abdominal Hernia, Istituto Clinico Sant’Ambrogio,
Milan, Italy
Giampiero Campanelli University of Insubria, General and Day Surgery Unit,
Center of Research and High Specialization for the Pathologies of Abdominal
Wall and Surgical Treatment and Repair of Abdominal Hernia, Istituto Clinico
Sant’Ambrogio, Milan, Italy
Marta Cavalli General and Day Surgery Unit, Center of Research and High
Specialization for the Pathologies of Abdominal Wall and Surgical Treatment and
Repair of Abdominal Hernia, Istituto Clinico Sant’Ambrogio, Milan, Italy
Contributors
xiii
xiv
Contributors
David C. Chen Lichtenstein-Amid Hernia Clinic, David Geffen School of
Medicine at the University of California, Los Angeles, Santa Monica, California,
USA
Max Fehily Hip and Groin Clinic, Spire Manchester Hospital, Manchester,
United Kingdom
Edward L. Felix Marian Regional Medical Center, Santa Maria, California, USA
René H. Fortelny Department of General, Visceral and Oncological Surgery,
Wilhelminen Spital, Vienna, Austria
Arthur I. Gilbert Miller-Miami Medical School, Hernia Institute of Florida,
Miami, Florida, USA
Dalila Patrizia Greco Day and Week Surgery Unit, Multi Specialist Surgery
Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Ivy N. Haskins Cleveland Clinic Comprehensive Hernia Center, Cleveland
Clinic Foundation, Cleveland, Ohio, USA
Saurabh Jamdar Department of General and Hernia Surgery, Central
Manchester Foundation Trust, Manchester Royal Infirmary, Manchester, United
Kingdom
David Jones Hip and Groin Clinic, Spire Manchester Hospital, Manchester,
United Kingdom
Doug Jones Hip and Groin Clinic, Spire Manchester Hospital, Manchester,
United Kingdom
Giel G. Koning Department of Surgery, Division of Vascular and Transplant
Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
Jan F. Kukleta Visceral Surgery Unit, Hirslanden Klinik Im Park, Zurich,
Switzerland
Karl A. LeBlanc Surgeons Group of Baton Rouge, Our Lady of the Lake
Physician Group, Baton Rouge, Louisiana, USA
Davide Lomanto Minimally Invasive Surgical Centre, Department of Surgery,
YLL School of Medicine, National University of Singapore, Singapore
Andrea Morlacchi General and Day Surgery Unit, Center of Research and High
Specialization for the Pathologies of Abdominal Wall and Surgical Treatment and
Repair of Abdominal Hernia, Istituto Clinico Sant’Ambrogio, Milan, Italy
John W. Murphy William Beaumont Hospital-Troy, Bloomfield Hills,
Michigan, USA
Philippe Ngo The Hernia Institute Paris, Paris, France
David K. Nguyen Department of Surgery, David Geffen School of Medicine at
the University of California, Los Angeles, Santa Monica, California, USA
Giovanni Andrea Padula CERGAS, Centre for Research on Health and Social
Care Management, Università Bocconi, Milan, Italy
Edouard P. Pélissier The Hernia Institute Paris, Paris, France
Alexander H. Petter-Puchner Department of General, Visceral and Oncological
Surgery, Wilhelminen Spital, Vienna, Austria
Brian E. Prebil Center for Minimally Invasive and Robotic Surgery, Peoria,
Arizona, USA
Michael J. Rosen Cleveland Clinic Comprehensive Hernia Center, Cleveland
Clinic Foundation, Cleveland, Ohio, USA
Jacob Rosenberg Department of Surgery, Herlev Hospital, Herlev, Denmark
Aali J. Sheen Department of General and Hernia Surgery, Central Manchester
Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom
Marc Soler Centre de Chirurgie Pariétale, Cagnes sur Mer, France
Eva Lourdes Sta. Clara Minimally Invasive Surgical Centre, Department of
Surgery, YLL School of Medicine, National University of Singapore, Singapore
Shirin Towfigh Beverly Hills Hernia Center, Beverly Hills, Cedars-Sinai
Medical Center, Department of Surgery, California, USA
Jerrold Young Miller-Miami Medical School, Hernia Institute of Florida, Miami,
Florida, USA
Contributors xv
1
1
G. Campanelli (Ed), Inguinal Hernia Surgery,
Updates in Surgery
DOI: 10.1007/978-88-470-3947-6_1, © Springer-Verlag Italia 2017
D.C. Chen ()
Lichtenstein-Amid Hernia Clinic, David Geffen School of Medicine at the University
of California, Los Angeles
Santa Monica, California, USA
e-mail: dcchen@ucla.edu
1
Lichtenstein Tension-free Hernioplasty
David K. Nguyen, Parviz K. Amid, and David C. Chen
1.1 Introduction
The inguinal hernia has plagued humankind since the advent of recorded history.
Edoardo Bassini’s seminal presentation to the Italian Surgical Society in 1887 of
a durable native tissue-based technique for restoring the integrity of the inguinal
anatomy and mechanics of the inguinal canal. Since then, numerous tissue repairs
considered the gold standard until the 1980s.
hernias even in the 19
th
understanding of hernia formation as a metabolic process not solely caused by
mechanical forces. Alterations to collagen type I to type III ratios and an imbalance
groin, leading to the development of inguinal hernias. The availability of suitable
groin hernia repairs.
-
stein Hernia Institute in Los Angeles began a protocol-based study to routinely
use prosthetic mesh for inguinal hernia repair. The Lichtenstein tension-free her-
nioplasty is a result of their efforts to circumvent the degenerative nature of the
groin hernia and the detrimental effects of suture line tension. Rather than placing
2
D.K. Nguyen et al.
-
the mesh, thus making intra-abdominal pressures favorable to the repair [1]. With
a tissue-based repair, these same mechanics place added tension on the suture line
predisposing it to failure and recurrence. Mesh positioned in this location pro-
vides a repair that is both therapeutic and prophylactic (Fig. 1.1) addressing the
and mechanical disturbances.
1.1.1 Preoperative Evaluation
an inguinal hernia or its complications may leave the patient at risk for infection,
testicular atrophy or loss, hematoma or seroma formation, nerve entrapment,
Fig. 1.1
black dotted line is not recommended due to tension. The solid black
line
3
1 Lichtenstein Tension-free Hernioplasty
should be discussed as part of the informed consent.
advanced age or severe comorbidities deaths may occur. Elective hernia surgery
or the morning of surgery. They are instructed not to shave the incision site as
1.1.2 Equipment
A sheet of prosthetic mesh measuring 7.5 ×
porous polypropylene meshes are preferred because their structure is more
aponeurosis meet (Fig. 1.2). In the case of a femoral hernia, the mesh may be
Fig. 1.2 Standard shape
the inguinal ligament
and the lateral border of
the rectus sheath
4
D.K. Nguyen et al.
1.1.3 Patient Positioning
The patient is placed in the supine position on the operating room table.
1.1.4 Technique of Anesthesia
-
1.1.4.1 Subdermal Infiltration
a 25 gauge needle into the subdermal tissue parallel to the surface of the skin.
intravascular infusion. This step blocks subdermal nerve endings and reduces the
local anesthesia.
1.1.4.2 Intradermal Injection and Creation of Skin Wheal
1.1.4.3 Deep Subcutaneous Injection
1.1.4.4 Subaponeurotic Injection
the remainder of the subcutaneous tissues overlying the aponeurosis and canal
pubic tubercle and around the neck and inside the indirect hernia sac is required to
5
1 Lichtenstein Tension-free Hernioplasty
prolong the analgesic effect.
1.1.5 Sedation
Fig. 1.3 Intradermal
Fig. 1.4
Intradermal
Skin
Subcutaneous fat
6
D.K. Nguyen et al.
1.1.6 Operative Preparation
into the scrotum is present. A dose of preoperative prophylactic antibiotic can be
considered depending on practice patterns but is not required for clean, elective
cases.
1.1.7 Incision and Exposure
internal ring.
1.1.8 Procedure
is then freed from the underlying internal oblique muscle until the internal
Fig. 1.5 Subaponeurotic
7
1 Lichtenstein Tension-free Hernioplasty
of the inguinal canal to accommodate the mesh prosthesis (Fig. 1.6). The mesh
should overlap the internal oblique aponeurosis by at least 3 cm above the
cm caudal to the pubic tubercle. When lifting the cord, care should be taken
and preserved.
3. The cremasteric sheath is incised longitudinally at the level of the deep ring
of chronic groin pain and orchialgia.
ligation. Ligation of the sac may cause of early postoperative nociceptive pain
and does not affect the rate of recurrence. With a large hernia sac resection of
the sac may be preferred to prevent pseudo-recurrence and to interrogate the
Fig. 1.6