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 posterior preperitoneal approach.

Posterior repair iliopubic tract repair and Nyhus technique is performed by dividing the layers of the abdominal wall superior to the internal ring and entering the properitoneal space. Inguinal and femoral hernias are the most common problems primary care physicians encounter that require surgical intervention. The symptoms vary considerably, including abdominal pain, a mass in the anterior abdominal wall or signs of incarceration with or without intestinal obstruction.

Average of 12 months range: This is a corrected version of the article that appeared in print. Type I—indirect inguinal hernia.

Hernias – Surgical Treatment – NCBI Bookshelf

The nyhuss resolution appears to be directly influenced by the size of the umbilical ring. The reported recurrence rates for surgically treated hernias vary widely, depending on the length and diligence of the follow-up period. But changes in the contents lead more commonly to the hernia’s becoming a true disease entity.

The diagnosis of recurrent herniation is generally straightforward. It was Bassini in who introduced and established tactical surgical principles with excellent results by repairing the posterior wall of the inguinal canal and reducing of the internal inguinal ring. In nyhuus reports, the recurrence rate varies from 5 to 8 percent for indirect hernias and is slightly higher for direct hernias.

Several studies have demonstrated that this approach is safe and involves only minimal use of pain medication.

Inguinal hernia repair. The Nyhus posterior preperitoneal operation.

However, extensive accumulated experience with the hernia mesh has begun to alleviate many of these concerns, and tension-free repair continues to gain njhus. Different etiological factors, such as increased intra-abdominal pressure in pregnancy, intra-abdominal tumors, chronic obstructive lung disease, ascites, chronic intestinal obstruction, and adiposityor pathological changes in connective tissue of the abdominal wall, are blamed, without conclusive significance.


Primary hernias occur mostly in females, secondary hernias in both females and males and rarely with an incarceration. Spieghelian Hernia Hernias of the linea semilunaris occur usually at the intersection with the linea semicircularis arcuata. Women may be predisposed to femoral herniation due to weakness of the pelvic floor musculature from previous childbirth Figure 4. The development of this nyhux of hernia requires a potential hernia sac, which is provided by the processus vaginalis.

Vague upper abdominal pain and nausea associated with epigastric tenderness may be present.

Surgical Options in the Management of Groin Hernias

Any factor that impairs normal wound healing may contribute to the development of incisional hernia. Hernias may include intra- and retroperitoneal organs, either permanently or intermittently. Laparoscopic hernia repair has become increasingly popular in the past few years, but the technique has also sparked significant controversy. Incarceration is common, especially in smaller hernias, but strangulation is unusual.

Inguinal hernia repair. The Nyhus posterior preperitoneal operation.

Reprints are not available from the authors. McVay open anterior repair. This is the nerve most commonly injured during open herniorrhaphy.

Table II Methods of hernia repair. Laparoscopic herniorrhaphy is becoming a more nyhud procedure. The disadvantages of spinal anesthesia include the time required for the anesthetic to be placed and the possibility of incomplete sensory blockade. PMC ] [ PubMed: However, it may be difficult to identify this problem in patients with scarring from a previous repair. The group 3 hernia repairs Lichtenstein and Nynus techniques use the same initial approach as open anterior repair.

These procedures have not provided pain relief in all patients. This is a wonderful source of information for the young surgeon in training, as it makes one of the most complex areas of the body easy to grasp and understand.


Note the lush innervation of this region. Create a personal account to register for jernia alerts with links to free full-text articles.

No mechanism of preventive care is known, and surgical repair is almost always necessary. Today, there is a great variety of surgical procedures available for the repair of inguinal hernia. Average of 10 months range: Whether this will also be true for laparoscopic herniorrhaphy remains to be seen. Classification Until now, a general classification system that includes nyhhs kinds of hernias is not available.

Transabdominal preperitoneal laparoscopic repair. Since that time, three laparoscopic procedures have been established: In girls, the hernial sac should be sutured under the obliquus internus muscle for fixation of the rotundum ligament.

Ultrasound examination of the inguinal region with the patient in the supine and upright positions and with the Valsalva maneuver has been reported to have a diagnostic sensitivity and specificity of greater than 90 percent. Init was Lichtenstein who advocated and used mesh to bolster the repair of both direct and recurrent hernias.

The figures are well crafted, and the color plates are excellent. Literature review and clinical outcome. Umbilical Hernia The umbilicus is a natural hernial opening in the abdominal wall. Surg Clin North Am. Even skilled examiners may be incorrect in up to 30 percent of cases. However, instead of suturing the jernia layers together to repair the hernia defect, the surgeon uses a prosthetic, nonabsorbable mesh.

In such patients, additional open anterior repairs have a higher failure rate and an increased rate of complications.