Herniorrhaphy

Definition
  • Repair of a herniation (protrusion) of the abdominal contents, caused by a musculofascila defect in the abdominal wall or groin area.
  • In the inguinal/ femoral regions, two types of herniation commonly occur; direct or indirect.
    1. Direct hernia: Usually resulting from stress, causing the peritoneum to bulge through the fascia in the groin area. The peritoneal bulge (sac) may contain abdominal viscera.
    2. Indirect Hernia: Caused by a congenital defect in the internal abdominal ring, causing the peritoneum to bulge along the spermatic cord. It may or may not contain abdominal viscera.
  • A hernia can occur within an old scar that is usually located in the abdominal (ventral) region, and is referred to as an incision hernia.
  • Hernias are either reducible or irreducible that is incarcerated. The contents of an incarcerated hernia may become strangulated, compromising the viability of trapped tissues and thus necessitating their resection in addition to the herniography.
Position
  • Supine, with arms extended on armboards
Incision Site
  • Groin area, right or left oblique.
Packs/Drapes
  • Laparotomy pack or minor pack
  • Four folded towels
Instrumentation
  • Basic tray or minor tray
  • Self retraining retractor
Supplies/ Equipment
  • Basin set
  • Suction
  • Needle counter
  • Penrose drain
  • Dissector sponges
  • Sutures
  • Solutions – saline, water
  • Synthetic mesh
  • Skin closure strips
Procedure
  1. The surgeon begins the procedure by incising the groin.
  2. The incision is deepened using the Metzenbaum scissors and cautery is used to control small bleeders.
  3. Both blunt and sharp dissections are used to gain access to the hernia.
  4. After incising the fascia that lies over the spermatic cord (male), several small hemostats are placed on the edge of the incised fascia.
  5. If direct, the surgeon will begin the suture the defect using interrupted suture of varying materials
  6. If indirect, the surgeon will dissect the sac away from the cord using Metzenbaum scissors, the sac is opened and the edges grasped with hemostasis.
  7. The contents of the sac are pushed toward the abdomen and if small, the sac may be lighted in place.
Perioperative Nursing Considerations
  1. The pensrose drain should be moistened with saline before use.
  2. Synthetic Mesh is often used to repair recurrent hernias or large ventral hernias.
  3. A specimen will be collected only during an indirect herniorrhaphy.
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