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Title
1. Introduction and Surgical Approach
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a. Ilioinguinal Nerve Block
2. Identify Hernia Sac in Preperitoneal Space
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a. Open External Oblique
b. Identify Ilioinguinal and Iliohypogastric Nerves
c. Enter Medially through Internal Oblique
d. Identify Transversalis Fascia
e. Identify Inferior Epigastric Vessels and Peritoneum Lateral to Them
f. Add More Local Anesthetic to Peritoneum
g. Identify Hernia Sac and its Relationship to Epigastric Vessels
3. Encirclement of Hernia Sac
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a. Identify Cord Contents
b. Gentle Dissection of Hernia Sac from Surrounding Contents
4. Develop the Preperitoneal Space
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a. Identify Cooper's Ligament
b. Identify Spermatic Cord (Spermatic Vessels & Vas Deferens)
c. Identify Reflection of Peritoneum
d. Feel for Iliac Vessel Pulse
e. Retraction of Hernia Sac Superiorly with Sponges
5. Placement of Mesh
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a. Careful Placement to Avoid Kinking of Mesh
b. Removal of Sponges to Avoid Mesh Disruption
c. Suture to Transversalis Fascia to Prevent Mesh Rotation
6. Closure
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a. Close External Oblique
b. Close Skin
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Minimally Invasive Open Preperitoneal Inguinal Hernia Repair
Michael Reinhorn, MD, MBA, FACS
Tufts University School of Medicine
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General Surgery
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Authors
Michael Reinhorn, MD, FACS
Filmed At:
Tufts University School of Medicine
Article Information
Publication Date
7/30/2014
Article ID
8
Production ID
0053
Volume
2014
Issue
8
DOI
https://doi.org/10.24296/jomi/8