Surg Clin North Am. Dec;78(6) Inguinal hernia repair. The Nyhus posterior preperitoneal operation. Patiño JF(1), García-Herreros LG, Zundel N. The Nyhus Posterior Preperitoneal Operation The repair of inguinofemoral hernias constitutes the most widely performed general surgical procedure. Adapted with permission from Nyhus LM, Klein MS, Rogers FB. Inguinal hernia. Curr Probl Surg ;

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Nyhus and Condon’s Hernia, 5th Edition

Get immediate access, anytime, anywhere. Email Alerts Don’t miss a single issue. McVay open anterior repair. Recurrence is the most common long-term complication of inguinal herniorrhaphy.

Either general or regional spinal anesthesia may be used in these patients. An indirect hernia passes lateral to the inferior epigastric vessels and thus is outside of Hesselbach’s triangle Figure 2while a direct hernia is medial to the epigastric vessels and therefore within the confines of this space Figure 3.

Tension-free repair can be performed using any type of anesthesia. In contrast, tension-free repair using mesh, as well as other types of hernia repair, may be comfortably and safely completed with patients receiving only local anesthesia. Want to use this article elsewhere? Laparoscopic hernia repair has become increasingly popular in the past few years, but the technique has also sparked significant controversy.

Surgical Options in the Management of Groin Hernias. 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. Reprints are not available from the authors.


Instead, they are acquired by the development of tissue deficiencies of the transversus abdominis muscle, which makes up the floor of the inguinal canal. Please review our privacy policy. Following initial herniorrhaphy, complication and recurrence rates are generally low.

Nyhus and Condon’s Hernia

However, extensive accumulated experience with the hernia mesh has begun to alleviate many of these concerns, and tension-free repair continues to gain popularity. Bilateral hernias may also be addressed simultaneously, using either an open or a laparoscopic procedure.

Women may be predisposed to femoral herniation due to weakness of the pelvic floor musculature from previous childbirth Figure 4. With very large defects or with fascia of marginal quality, the tension of the sutures can lead to recurrence.

This is the nerve most commonly injured during open herniorrhaphy.

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

There are 72 national and international contributors covering a variety of old and new topics in pages. N Engl J Med. The collection begins with historical insight into the diagnosis and repair of hernias in decades and centuries gone by.

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

Demographic, classificatory, and socioeconomic aspects of hernia repair in the United States. Information from references 5and 10 through Surgical repair of a hernia is not warranted in terminally ill patients with no evidence of incarceration. Nyhue content is owned by the AAFP.


Average of 12 nyhsu range: Choose a single article, issue, or full-access subscription. In some series, the laparoscopic approach has been 40 percent more costly than other approaches. Even skilled examiners may be incorrect in up to 30 percent of cases. In such patients, additional open anterior repairs have a higher failure rate and an increased rate of complications.

The development of femoral herniation is not well understood. Nerve entrapment is perhaps the herniqs significant complication of inguinal herniorrhaphy. Rutkow and Robbins This repair reconstructs the inguinal canal without using a mesh prosthesis. The femoral branch of this nerve supplies sensation to the skin of the anterior thigh 2 Figure 5. The long-term impact of complications secondary to untreated herniation is not fully known. The reported recurrence rates hyhus surgically treated hernias vary widely, depending on the length and diligence of the follow-up period.

Internal inguinal ring normal i.

Surgical Options in the Management of Groin Hernias

Total extraperitoneal laparoscopic repair. Type III—posterior wall defects. Hernia recurrence rates of less than 4 percent have been reported for herniorrhaphies performed without prosthetic mesh by skilled surgeons.