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: 73

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

   
 

The hernia may be approached from above using a McVay technique to open the inguinal floor, or it may be approached through a small incision directly over the bulge and below the inguinal ligament. The latter has the advantage of not disrupting a normal inguinal floor, and is less traumatic. The contents of the hernia sac must be clearly visualized and deemed viable before gentle operative reduction is attempted. Once the hernia is reduced, the defect is bounded by the edges of the opened femoral sheath.     

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Hernia Technique Master Class: 74

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

   
 

If the sac contents are viable but non-reducible, there are two options for widening the neck of the femoral canal. The lacunar ligament can be opened medially or the inguinal ligament can be opened anteriorly. In each case, a right angle clamp clamp is inserted just above each structure to protect against injury to structures which may be above such as an aberrant obturator artery. The ligaments are then carefully opened with a #15 blade under direct vision.      

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Hernia Technique Master Class: 75

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

   
 

If there is non-viable bowel in the sac, it must be secured while dissection proceeds. Additional length of bowel can be delivered after the widening maneuvers described. If this is not possible, an abdominal counterincision may be necessary. This holds true for the McVay approach as well.      

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