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28 Cards in this Set
- Front
- Back
Areas of inguinal occurrence
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inguinal canals, femoral rings, umbilicus, epigastric, and hiatal
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contributing factors
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age, gender, previous surgery, obesity, nutrition, pulmonary disease, cardiac disease
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anatomy related to type of hernia: inguinal
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inguinal area lateral to the pubic area
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anatomy related to type of hernia: femoral
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very upper edge f thigh, just below inguinal area
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anatomy related to type of hernia: incisional or ventral
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area of previous incision or front of the abdomen
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anatomy related to type of hernia: umbilicus
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umbilicus
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anatomy related to type of hernia: spigelian
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lateral to the linea alba (center line of abdominal muscle)
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Direct hernias
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occur within the Hesselbach triangle.
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Indirect Hernias
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occur anywhere but in Hesselbach's triangle.
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Supplies for inguinal hernia repair
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Minor basic tray & self retaining retractor. (weitlander or gelpi) -Laparotomy pack - suction, x-ray sponges, bovie pencil, penrose drain, suture (absorbable and non-absorbable), ESU
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Patient position etc
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Supine
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Anesthetic
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Local (spinal) or regional block
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Prep
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above and sl. lateral to umbilicus, groin, external genitalia
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Suture
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transversalis fascia, heavy non-absorbable (0 or 1 prolene); mesh/plus MAY be used here -Scarpas fascia- medium absorbable (2-0 or 3-0) vicryl -Skin nonasborbable (4-0) or staples
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procedure for inguinal herniorraphy
incise via inguinal hernia or oblique incision - hemostasis |
-retract skin and subcutaneous (goelet, army-navy, or appendix richardson) - open external oblique aponeurosis (scalpel and forceps)
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2- preserve nerves - open cremaster muscle
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2 retract spermatic cord with moistened penrose drain- pass on a kelly 2- explore cord for indirect sac (if present), dissect away from cord
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3- open sac & return abdominal contents to peritoneal cavity - purse string suture for base of sac
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-remove excess of sac -if possible approximate transversalis fascia edges with non-absorbable suture (0 prolene or Surgilon) on control release needle
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4- procedure for inguinal herniorraphy cont. - if unable, may need to suture fascia to cooper's ligament
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-cremaster muscle closed - close exterior oblique m. aponeurosis, scarpa's fascia and skin - dress wth telfa & 4x4 gauze; may also use steri strips
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instructions from surgeon
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Verbal and written: Discharge planning begins on admission Wound care- report signs of infection - Males wear scrotal support Ice packs to decrease swelling
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Activity (instructions cont.)
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occupation related - use proper body mechanics- early ambulation
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advantages of herniorraphy
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faster return to activity - less post-op adhesions - smaller incisions (3-4) - Less post- op pain - minimal dissection - better for bilateral and recurrent hernias
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Disadvantages of herniorraphy
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- higher costs - higher learning curve - longer operating time - need for general anesthesia - more visceral and vascular complications
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laparoscopic hernia repair preparation supplies instruments and equipment
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gen.gyn laparoscopy tray and camera- laparoscopy pack -suction, x-ray sponges, bovie pencil, clip applier, mesh, trocars, insufflation tubing, irrigation, aspiration tubing, suture( absorbable and non) -ESU - tower with camera, monitor, insufflator, light source, VCR
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patient position and prep
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reverse trendelenberg, anesthesia (general) - prep above and lateral to umbilicus, groin, external genitalia
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1 create pneumoperitoneum (carbon dioxide gas via verres needle attached to insufflation tubing) - trocar placement (2nd & 3rd under direct visualization via camera & monitor)
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-hemostasis (bovie) - identify landmarks (vas deferens, spermatic vessels, arteries and veins
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2 Dissect fat and peritoneum away from muscle wall and spermatic cord (dissectors and laparoscopic scissors) - place mesh in direct space defect
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Place mesh over defect in inguinal area + secure with staples - Re-approximate peritoneal flaps with staples
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3 Irrigate peritoneal cavity- remove instruments & release pneumoperitoneum
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Close incisions - Steri strips for dressing
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Possible Complications Lap Hernia Rep.
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Reccurence, Nerve injury, Ischemic orchitis, and testicular atrophy, loss of bowel function, infection, complications associated with all open procedures (e.g., hemorrhage, dehiscence), etc.
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