c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Hernia Technique Master Class: 34

A D V E R T I S E M E N T

   
 

A wide-necked sac may be closed using a purse-string suture of 2-0 silk under direct vision with the sac open. After the ends of the purse string are tied, the ends are passed around the ligated base of the sac and tied again to close the gaps in the purse string.      

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Hernia Technique Master Class: 35

A D V E R T I S E M E N T

   
 

With a large or thick-walled indirect sac, the presence of a sliding hernia must be ruled out. A sliding hernia is defined by the wall of a hollow viscus constituting one wall of the hernia sac. This most commonly is the cecum on the right and the sigmoid on the left. The sac should be opened at its thinnest portion to identify the attached organ. The organ must then be separated from the sac, mobilized and reduced into the abdomen to complete the repair. Rarely, an abdominal counter-incision above the inguinal canal must be made to safely reduce an extensive sliding component.     

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Hernia Technique Master Class: 36

A D V E R T I S E M E N T

   

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If the medial side of the sac is thick, the possibility of a sliding hernia containing bladder sneaking around the inferior epigastric vessels must be considered. The bladder is separated from the sac and reduced. An attempt may be made to close the residual defect in the case of any sliding hernia using a purse string suture on the edges of the remaining peritoneum, but this may not be possible, and may not be necessary if a mesh tension-free repair is done as is usually the case in such a situation.   

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This page was last modified on 2/10/2009.