HERNIORRHAPHY
Definition
Repair of a herniation (protrusion) of the abdominal contents, caused by a musculo-fascila defect in the abdominal wall or groin area.

Discussion * In the inguinal/ femoral regions, two types of herniation commonly occur; direct or indirect. 1. Direct hernia: Usually resulting from stress, causing the peritoneum to bulge through the fascia in the groin area. The peritoneal bulge (sac) may contain abdominal viscera. 2. Indirect Hernia: Caused by a congenital defect in the internal abdominal ring, causing the peritoneum to bulge along the spermatic cord. It may or may not contain abdominal viscera. * A hernia can occur within an old scar that is usually located in the abdominal (ventral)region, and is referred to as an incision hernia. * Hernias are either reducible or irreducible that is incarcerated. The contents of an incarcerated hernia may become strangulated, compromising the viability of trapped tissues and thus necessitating their resection in addition to the herniography.

Position * Supine, with arms extended on arm boards

Incision Site * Groin area, right or left oblique.

Packs/Drapes * Laparotomy pack or minor pack * Four-folded towels

Instrumentation * Basic tray or minor tray * Self retraining retractor

Supplies/ Equipment * Basin set * Suction * Needle counter * Penrose drain * Dissector sponges * Sutures * Solutions – saline, water * Synthetic mesh * Skin closure strips

Procedure 1. The surgeon begins the procedure by incising the groin. 2. The incision is deepened using the Metzenbaum scissors and cautery is used to control small bleeders. 3. Both blunt and sharp dissections are used to gain access to the hernia. 4. After incising the fascia that lies over the spermatic cord (male), several small hemostats are placed on the edge of the