Herniorrhaphy
You don't need to be Editor-In-Chief to add or edit content to WikiDoc. You can begin to add to or edit text on this WikiDoc page by clicking on the edit button at the top of this page. Next enter or edit the information that you would like to appear here. Once you are done editing, scroll down and click the Save page button at the bottom of the page.
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [1] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Overview
| Intervention: Herniorrhaphy | ||
|---|---|---|
| ICD-10 code: | ||
| ICD-9 code: | 53 | |
| Other codes: | ||
|
WikiDoc Resources for Herniorrhaphy | |
|
Articles | |
|---|---|
|
Most recent articles on Herniorrhaphy Most cited articles on Herniorrhaphy | |
|
Media | |
|
Powerpoint slides on Herniorrhaphy | |
|
Evidence Based Medicine | |
|
Clinical Trials | |
|
Ongoing Trials on Herniorrhaphy at Clinical Trials.gov Trial results on Herniorrhaphy Clinical Trials on Herniorrhaphy at Google
| |
|
Guidelines / Policies / Govt | |
|
US National Guidelines Clearinghouse on Herniorrhaphy NICE Guidance on Herniorrhaphy
| |
|
Books | |
|
News | |
|
Commentary | |
|
Definitions | |
|
Patient Resources / Community | |
|
Patient resources on Herniorrhaphy Discussion groups on Herniorrhaphy Patient Handouts on Herniorrhaphy Directions to Hospitals Treating Herniorrhaphy Risk calculators and risk factors for Herniorrhaphy
| |
|
Healthcare Provider Resources | |
|
Causes & Risk Factors for Herniorrhaphy | |
|
Continuing Medical Education (CME) | |
|
International | |
|
| |
|
Businness | |
|
Experimental / Informatics | |
Herniorrhaphy (Hernioplasty, Hernia repair) is a surgical procedure for correcting hernia. A hernia is a bulging of internal organs or tissues, which protrude through an abnormal opening in the muscle wall. Hernias can occur in the abdomen, groin, and at the site of a previous surgery.
Techniques
Herniorraphy, or hernioplasty, is now often performed as an ambulatory, or "day surgery," procedure. Almost 700,000 are performed each year in the United States.
These techniques can be divided into four groups.[1]
Groups 1 and 2: open "tension" repair
A workable technique of repairing hernia was first described by Bassini in the 1800s;[1][1] the Bassini technique was a "tension" repair, in which the edges of the defect are sewn back together without any reinforcement or prosthesis. In the Bassini technique, the conjoint tendon (formed by the distal ends of the transversus abdominis muscle and the internal oblique muscle) is approximated to the inguinal canal and closed. [1]
Although tension repairs are no longer the standard of care due to the high rate of recurrence of the hernia, long recovery period, and post-operative pain, a few tension repairs are still in use today; these include the Shouldice and the Cooper's ligament/McVay repair.[1] [1]
The Shouldice techniques is a complicated four layer reconstruction, however, it has relatively low reported recurrence rates.[1]
An operation in which the hernia sac is removed in addition to tension repair is described as a 'herniotomy'.
Group 3: open "tension-free" repair
Almost all repairs done today are open "tension-free" repairs that involve the placement of a synthetic mesh to strengthen the inguinal region; some popular techniques include the Lichtenstein repair (flat mesh patch placed on top of the defect)[1], Plug and Patch (mesh plug placed in the defect and covered by a Lichtenstein-type patch), Kugel (mesh device placed behind the defect), and Prolene Hernia System (2-layer mesh device placed over and behind the defect). This operation is called a 'hernioplasty'. The meshes used are typically made from polypropylene or polyester, although some companies market Teflon meshes and partially absorbable meshes. The operation is typically performed under local anesthesia, and patients go home within a few hours of surgery, often requiring no medication beyond aspirin or acetaminophen. Patients are encouraged to walk and move around immediately post-operatively, and can usually resume all their normal activities within a week or two of operation. Recurrence rates are very low - one percent or less, compared with over 10% for a tension repair. Rates of complications are generally low but they can be quite serious, and can include chronic pain, ischemic orchitis, and testicular atrophy.[1][1]
Group 4: laparoscopic repair
In recent years, as in other areas of surgery, laparoscopic repair of inguinal hernia has emerged as an option. "Lap" repairs are also tension-free, although the mesh is placed within the preperitoneal space behind the defect as opposed to in or over it. It has no proven superiority to the open method other than a faster recovery time and a slightly lower post-operative pain score. Unlike the open method, laparoscopic surgery requires general anesthesia. It is usually more expensive and consumes more O.R. time than open repair, carries a higher risk of complications, and has equivalent or higher rates of recurrence compared to the open tension-free repairs.
Comparisons
In the UK a government committee called NICE[1] re-examined the data on laparoscopic and open repair (2004). They concluded that there is no difference in cost, as the increased costs of operation are offset by the decreased recovery period. Recurrence rates are identical. They found that laparoscopic repair results in a more rapid recovery and less pain in the first few days. They found that lap repair has less risk of wound infection, less bleeding and less swelling after surgery (seroma). They also reported less chronic pain, which can last for years and in one in 30 patients can be severe. A recent, large American study[1] found that recurrence within two years of operation after lap repair was 10% compared with 4% after open surgery. Both of these results however are considered poor by international standards and suggest that the surgeons were inexperienced, particularly in lap repair.
Open mesh repair or laporascopic mesh repair are good and have shown reduced recurrences or early recovery. Complications related to the use of mesh include infection, mesh migration, adhesion formation, erosion into intraperitoneal organs, and chronic pain - due probably to entrapment of nerves, vessels or the vas deferens.[1] Such complications usually become apparent weeks to years after the initial repair, presenting as abscess, fistula, or small bowel obstruction.[1][1] More recently, concerns have been raised about the possibility of obstruction of the vas deferens as a result of the fibroblastic reaction to the mesh.[1][1]
Dr. Desarda's repair
Recently introduced "Dr.Desarda's repair" is without mesh or any foreign body.[1][1] Even sutures used are absorbable, a thing which was never imagined till today. An undetached strip of the external oblique aponeurosis goes behind the cord to form a new posterior wall between the inguinal ligament and the muscle arch. There are no recurrences, no pain, patient can drive a car and go to office in 3-4 day. The claims of novelty and significance of this approach have, however, been questioned by some.[1] Readers are requested to go through the reply given by the author of this new technique to some one who questioned. [1]
References
External links
- American College of Surgeons article on Open Hernia Repair
- American College of Surgeons article on Laparoscopic Hernia Repair
- Dr Desarda’s Hernia Repair
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
