c l i n i c a l f o l i o s : n a r r a t i v e





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Hernia Technique Master Class: 52

A D V E R T I S E M E N T

   

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The floor is tested for strength. If the patient was done under local anesthesia, he or she can be asked to cough. Aside from the benefit of avoiding general anesthesia, the advantage of local is that the patient won’t cough violently as when extubated and potentially compromise the repair. There is a theoretical potential for widening the femoral canal with the iliopubic tract type hernia repair.    

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Hernia Technique Master Class: 53

A D V E R T I S E M E N T

   
 

The pectineal/Cooper’s ligament repair devised by Lotheisien and popularized by McVay relys on the Pectineal ligament to anchor the medial part of the repair. The cephalad part of the repair is the falx as in the iliopubic tract repair. In addition to opening the transversalis fascia, the preperitoneal fat is pushed back off the lacunar ligament to expose pectineal ligament up to the external iliac vessels.      

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Hernia Technique Master Class: 54

A D V E R T I S E M E N T

   
 

The falx is first sewn to Pectineal ligament with either interrupted or continuous sutures of 2-0 prolene. Because Pectineal ligament diverges posteriorly from medial to lateral, it is further to stretch falx down to it, and would result in tension if the falx were not released with a relaxing incision in the posterior lamina of the rectus sheath, consisting of transversus and internal oblique aponeuroses. The anterior lamina of external oblique has no connection to transversalis and is not not incised. At the external iliac vessels, a transition stitch from falx to edge of femoral sheath, to iliopubic tract and inguinal ligament is taken and the repair completed as a Shouldice repair is done. The transition stitch can be used to narrow the internal end of the femoral canal, and the McVay has thus been commonly used as one way to repair a femoral hernia defect.    

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This page was last modified on 2/10/2009.