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





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

 

Hernia Technique Master Class: 64

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

   

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The completed repair is shown. A small percentage of patients will develop persistent inguinodynia due to nerve entrapment by the mesh, and some surgeons routinely divide the ilioinguinal nerve to avoid this complication. Mild to moderate inguinodynia is first treated with medication. Localization of the involved nerve is done with test injections of local anesthesia. If this condition occurs and the nerve is intact, the nerve can be chemoablated or it can later be divided beneath the external oblique in virgin territory lateral to the deep inguinal ring.   

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Hernia Technique Master Class: 65

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

   

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After all the open repairs, the cord is replaced in the inguinal canal, the Penrose removed while holding the cord to prevent torsion, and the external oblique is loosely closed.     

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Hernia Technique Master Class: 66

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

   

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The external oblique closure is shown. A loose closure and wide superficial ring prevents subfascial hematoma from disrupting the repair, and prevents compression of the cord. The testicle is pulled down at the conclusion of the case. If the patient was done under local, he is asked to put pressure over the repair while moving to the gurney and for 15 minutes to decrease the chance of hematoma.    

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