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Surg Clin North Am. Dec;78(6) Inguinal hernia repair. The Nyhus posterior preperitoneal operation. Patiño JF(1), García-Herreros LG, Zundel N. A hernia is an outpouching of the parietal peritoneum through a preformed or secondarily established hiatus. If the hernia Table Ib. Nyhus hernia classification. Adapted with permission from Nyhus LM, Klein MS, Rogers FB. Inguinal hernia. Curr Probl Surg ;

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The first description of an inguinal hernia appears in the Ebers papyrus B.

The writing is rich with details and illustrations. Average of 24 months range: Results of a multicenter trial.

The first attempts to reduce the hernial orifice were made by MarcySteeleand Czerny The hernia is present in about one to every five birth, the incidence in black infants being up to eight times higher than in white infants. In the United States, approximately 96 percent of groin hernias are inguinal and 4 percent are femoral.

Nyhus and Condon’s Hernia | JAMA Surgery | JAMA Network

N Engl J Med. The develop typically in locations where larger blood vessels or the spermatic cord lie, or where previous incisions were made. Management includes operative therapy with repositioning of the hernial content and continuous suture, using local anesthesia in elective repair in adults or general anesthesia in children or in an emergency situation.

The use of alloplastic material was introduced by Stock and Usher heernia Except for pain or a dull dragging sensation in the groin, the common reducible inguinal hernia usually does not cause significant symptoms. Support Center Support Center. Since inguinal herniorrhaphy can be performed using a variety of techniques, the approach can be individualized.


Urinary retention or a delay in the return of normal lower extremity sensation may mandate overnight observation following herniorrhaphy performed with nygus anesthesia. Wound hematomas and superficial wound infections are the most common problems, and they usually nyhua to conservative measures.

A randomized prospective trial. Until now, a general classification system that includes all kinds of hernias is not available. At present, two different major principles of repair are established: Most herniia these patients are women. Finally, these approaches can be particularly effective in patients with hernia recurrence after traditional open herniorrhaphy. The major nerves in the inguinal region are the ilioinguinal, iliohypogastric and genitofemoral nerves.

Almost all groin hernias should be surgically repaired. Purchase access Subscribe to JN Learning for one year. Hhernia ilioinguinal nerve traverses the inguinal canal near the external inguinal ring and provides unilateral sensory innervation to the pubic region and the upper portion of the scrotum or the nyus majora.

The laparoscopic approach, similar to the open posterior approach, allows hernia repair to be performed in a previously untouched space.

Surgical Options in the Management of Groin Hernias

Table Ib Nyhus hernia classification. The disadvantages of spinal anesthesia include the time required for the anesthetic to be placed and the possibility of incomplete sensory blockade. McVay open anterior repair.

Privacy Policy Terms of Use. This persistence does not imply the presence of a hernia, but means simply a potential for hernia formation. Further long follow-up as well as larger studies comparing the results of open and laparoscopic repairs are needed 48.

A case-controlled comparison of patients receiving workers’ compensation vs patients with commercial insurance. An intermediate position is taken by the interparietal hernias of the abdominal wall.

Correlating with the repair of inguinal hernias, many different operative techniques for incisional hernia have been introduced, most recently laparoscopic procedures. Purchase access Subscribe to the journal. Giant hernias may cause significant bodily discomfort by weight alone; Hernias may cause complaints from restriction of physical activity develop surface ulceration, or be displeasing on aesthetic and cosmetic grounds alone.


But changes in the contents lead more commonly to the hernia’s becoming a true disease entity.

It is probably best performed with the patient receiving regional or general anesthesia. Excellent results have been achieved with this approach, and reported recurrence rates have been less than 1 percent. General anesthesia provides the most comfort, but it has the highest risk.

Since the first Bassini procedure at the end of the last century, many different operative techniques have been introduced, most recently laparoscopic procedures.

In girls, the hernial sac should be sutured under the obliquus internus muscle for fixation of the rotundum ligament. Thus, an indirect hernia is the result of two herniq Classification Until now, a general classification system that includes all kinds of hernias is not available. The most common hernia in both sexes is the indirect inguinal hernia.

In some series, the laparoscopic approach has been 40 percent more costly than other approaches.

Surgical Options in the Management of Groin Hernias – – American Family Physician

Choose a single article, issue, or full-access subscription. After the fetal testis has descended into the scrotum from the retroperitoneum, the processus vaginalis normally obliterates, thereby removing this potential for herniation. Direct inguinal hernias are not generally congenital. Route jyhus a direct hernia.