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

 

Transperitoneal Hernia Repair: 1

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

   
 

Regardless of the defect (a large indirect shown here), the peritoneum is incised above the deep ring up to the medial umbilical ligament medially. Cutting farther medially risks injuring bladder. If the indirect sac is large, mobilization risks compromising cord blood supply and the sac is left in place as shown.      

Notes:

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Transperitoneal Hernia Repair: 2

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

   
 

Flaps of peritoneum and preperitoneal fat are dissected above and below exposing the iliopubic tract, falx, inferior epigastric vessels, rectuspectineal (Cooper's) ligament, vas, iliac vessels and spermatic vessels.      

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Transperitoneal Hernia Repair: 3

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

   
 

A non-absorbable mesh is then placed over the inguinal floor and stapled or tacked for initial fixation until collagen ingrowth occurs. The mesh is fixed to pectineal ligament, rectus and transversus abdominus (through transversalis fascia). No staples or tacks are placed below iliopubic tract laterally for fear of injuring lateral femoral cutaneous nerve.      

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This page was last modified on 3/1/1999.