Though there have been several classification systems for groin or inguinal hernias, none have been described for total classification of all ventral hernias of the abdomen. The change in the surgical approach and functional anatomy opened the doors for newer classifications. The authors have proposed a classification system based on the expected level of intraoperative difficulty for endoscopic hernia repair.
In the proposed classification, higher grades signify increasing levels of expected intraoperative difficulty. This functional classification grades groin hernias according to the preoperative predictive level of difficulty of endoscopic surgery. For multiple or pantaloon direct and indirect components hernias, grading is according to the dominant hernia. Bowel obstruction and strangulation are unsuitable for the total extraperitoneal TEP approach. Intraoperatively, the factors considered as predictors of the grade of difficulty include:.
Inguinal hernia surgery
Reducibility Degree of descent of the hernial sac Previous hernia repair. Small, indirect, incomplete, reducible hernia Hernial swelling limited to inguinal canal Endoscopically - the sac can be reduced completely and may not require transection or ligation Moderate-size direct hernia Swelling is present in standing and reduces in the supine position Thumb-sized defect in the direct floor Endoscopically, the sac needs to be dissected off from the fascia transversalis Reducible femoral hernia.
- Endoscopic Repair of Abdominal Wall Hernias.
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Moderate-size indirect, reducible inguinal hernia Hernial swelling sac extends beyond superficial ring, up to the neck of scrotum but does not descend to the testis Endoscopically - this type of hernia will require transection of sac and ligation of the proximal part of sac Large reducible direct hernia Involvement of the entire direct floor Big bulge on clinical examination over the triangle of Hesselbach Endoscopically, creation of space in the midline is difficult. There is anatomical distortion - stretching and lateral displacement of inferior epigastric vessel Recurrent groin hernia Endoscopically - difficult dissection in region of spermatic cord and the space lateral to it.
Large reducible indirect inguino-scrotal hernia Large sac extending up to the testis.
The testis cannot be palpated separately from hernia in erect position The sac may contain omentum or small bowel, which require manual reduction in supine position Endoscopically - the internal ring is enlarged with a wide-mouthed sac. There is difficulty in dissecting sac from cord structures. Medial displacement and stretching of the inferior epigastric vessels may occur. Large, complete, indirect inguinal hernia, which is only partially reducible or irreducible Irreducible femoral hernia The sliding component includes the bowel or bladder Endoscopically - the sac is bulky.
There are adhesions between contents of the sac and sac wall. The sac often needs to be opened and the contents reduced laparoscopically. Injury to the contents bowel, bladder and omentum while reducing them is likely. Completely reducible incisional hernia The margins of defect should be clearly palpable.
Primary hernia - partially reducible or irreducible Contents - omentum only Reducible incisional hernia at special operative sites such as Pfannensteil, subcostal incision or extended sternotomy incisions.
Cirugía Española (English Edition)
Primary hernia containing bowel, which is partially reducible or irreducible More planning in port placement and mesh fixation is required Lumbar hernia Colon needs to be reflected. Multiple scarred abdomen Multiple previous incisions Previous hernia repair recurrent incisional hernia Presenting as acute obstruction. Clinically, on examination bowel loop may give gurgling sensation and reduce partially on palpation. This can be distinguished from omentum on palpation and auscultation. Classification systems and groin hernias.
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Popular Features. New Releases. Description "Endoscopic Repair of Abdominal Wall Hernias" crystallizes the enormous experience of a team of minimal access surgeons who are leaders in the field of laparoscopic hernia repair. Written in an easy-to-read format, the book equips the general surgeon with do-it-yourself techniques using a step-by-step approach to endoscopic repair of hernias of the groin and abdominal wall. This edition has been revised and updated in view of the recognition accorded to herniology in the past decade.
The highlights of the book include: a new, simple and practical classification for abdominal wall hernias; line diagrams as well as corresponding operative photographs to delineate the endoscopic anatomy; innovations to reduce the cost of surgery; anaesthetic implications for endohernia repair; and sterilization techniques. This reference guide is invaluable for the young, aspiring surgeon as well as the trained laparoscopic surgeon.
Table of contents Foreword to the first edition; Addendum; Preface to the second edition; Preface to the first edition; Acknowledgements; Contributors; 1. Historical aspects of hernia repair; 2. Advent of minimal access surgery; 3.
Doody's review of the SAGES Manual of Hernia Surgery, 2nd Edition - SAGES
Endoscopic anatomy; 4. Classification of endoscopic repair of hernias; 5. Equipment and instruments; 6. Prosthetics and fixation devices; 7. Patient management - Our approach; 8. Anaesthesia for laparoscopic endohernia repair; 9.