1. Hernia Abdominal Wall Defect Potential for bowel obstruction
Congenital or acquired
Potential for bowel obstruction
Incarceration
Strangulation
May suggest underlying pathology
Hepatic disease, BPH, COPD, obstructing colon mass

2. Pertinent History Duration/onset Symptoms Prior Incarceration
Local
Obstructive
Nausea, emesis, pain, distension, obstipation
Prior Incarceration
Related comorbidity
Pulmonary, Constipation, Ascites
Operative risk

3. Pertinent Exam Location Reducible? Tender? Skin changes?
Palpable edges, Size?
Genitalia
Rectal

4. Common Hernias Umbilical Ventral Incisional Inguinal
Direct, indirect, femoral, obtuator

8. Bassini repair

9. Lichtenstein(Amid) hernia repair
Nerves and
vessels identified
Lichtenstein(Amid) hernia repair
Dome

10. Posterior view of the groin “myopectineal orifice” H. Fruchaud (1956)

12. Nomenclature in inguinal hernia repairs in adults
Shouldice= 3 layer tissue repair
Bassini repair- term often incorrectly used, specify details!
McVay-Lotheissen= use of suprapubic ligament
“Open mesh repair”- specify!
Lichtenstein= anterior open repair with mesh onlay
Mesh plug- with or without onlay (Rutkow)
Special designs- (Gilbert, Kugel)
TEP = lap. preperitoneal hernioplasty
TAPP= lap. Transabd. preperitoneal hernioplasty
Stoppa repair= Open wrapping of peritoneal sac with mesh, midline approach

13. onlay – inlay - underlay

15. Laparoscopic Ventral Hernia

18. Tension free? More than a fad! Reduces pain Reduces recurrences
Reduces overall costs

19. Umbilical Hernia Congenital Most close by age 3
May remain small and asymptomatic
Can increase with obesity, pregnancy, ascites, peritoneal dialysis
Typical umbilicus

21. Hernia outcome assessment
Past:
recurrence, complications, procedure cost
Future:
acute pain, chronic pain, convalescence time
..chronic herniorraphy pain represents a scientific challenge because the pathogenesis, diagnostic criteria, and therapeutic interventions all have been incompletely evaluated H. Kehlet, Hernia, 2002