Page 29 - herina surgery and possible lawsuits

Major techniques of hernia repair

Among the most notable contemporary classic henna tissue repairs are the Bassini, Halsted,

Shouldice and, McVay (Cooper Ligament) repairs. The most common prosthetic open repairs
done today are the Kugel patch repair, the Lichtenstein onlay patch repair, the PerFix plug
and patch repair, and the PROLENE Hernia System bilayer patch repair. Laparoscopic hernia
surgenes include TEP and TAPP.

Type of Anesthesia:

Surgery for inguinal hernia repair can be performed under all types of regional anesthesia,

general anesthesia and local anesthesia preferred. The anesthesia employed for hernia should
be a consensus choice between patient and surgeon.[63]

• Local anesthesia become widely popular because of its safety and open hernia surgery

required minimal handling of the hernial sac and its contents and it is effectively body
surface surgery. Many surgeons use surgery under local anesthesia where as others
use exclusive spinal or epidural anesthesia.

• At Lichtenstein hernia institute, initially field block was the mean of achieving local
anesthesia but later shifted to simple infiltration technique, because the field block
was blind procedure, time consuming, required larger volume of the local anesthetic

solution and did not always result m satisfactory anesthesia. Some time accidental
needle puncture of the ilioinguinal nerve resulted in prolonged postoperative pain,
burning, or electric shock sensation within the field of the ilioinguinal nerve

innervations.[64] Some study suggest intraoperative pain may be a problem,[65] so
combined ilioinguinal blockade and local infiltration anaesthesia is recommended for
groin hernia repair to reduce intra-operative pain. [66] Uncomplicated bilateral

inguinal hemioplasty m adults are feasible under local anesthesia with equally
comparable postoperative pain and recovery periods. [67]

Marre et al. in his study found that the open inguinal henna repair performed under local in

73% (n = 316), epidural in 21% (n = 94), or general in 6% (n = 25) anesthesia. [68] In another
study general anesthesia (GA) was used in 51%, spinal anesthesia (SA) in 10%, and local
anesthesia (LA) in 37%.[53]

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