Surg Clin North Am. Dec;78(6) Inguinal hernia repair. The Nyhus posterior preperitoneal operation. Patiño JF(1), García-Herreros LG, Zundel N. A hernia is an outpouching of the parietal peritoneum through a preformed or secondarily established hiatus. If the hernia Table Ib. Nyhus hernia classification. Adapted with permission from Nyhus LM, Klein MS, Rogers FB. Inguinal hernia. Curr Probl Surg ;

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The long-term impact of complications secondary to untreated herniation is not fully known. Sign in to make a comment Sign in to your personal account. In case of properly performed primary operation that means usually the reinforcement with alloplastic material, in regard to no mesh-free alternative. Fitzgibbons, Jr, MD, and A. Early studies showing acceptable outcomes for laparoscopic herniorrhaphy may reflect herhia same bias other procedure-focused centers have shown for open herniorrhaphy.

Average of 9 months range: Postoperative convalescence also contributes to absence from the work force. A broad portion of mesh is stapled to span both hernia defects. Average of 4 years range: The development of femoral herniation is not well understood.

These procedures have not provided pain relief in all patients. However, chronic neuralgia can develop.

Inguinal and femoral hernias are the most common problems primary care physicians encounter that require surgical intervention. In some series, the recurrence rate following repair of a recurrent hernia is as high as 30 percent, which is significantly greater than the recurrence rate after initial repairs.

Surg Clin North Am. The influence of the surgeon and this technique of primary closure after laparotomy was heria by Israelsson, who proved a suture-wound length ration of 4: Average of 12 months range: Laparoscopic or open inguinal herniorrhaphy? Patients occasionally respond poorly to a general anesthetic and require overnight hospitalization because of nausea, excessive sedation or urinary retention.


Management includes a transperitoneal or preperitoneal approach and hernia orifice closure with herna suture or mesh. With the recent development of new meshes an additional group should be added: The male-to-female ratio is 9: Hernia lumbalis presents abdominal wall or retroperitoneal outpouchings between the 12th rib and the iliac crest. In case of small hernias with a size of four or less centimeters an attempt to try nonabsorbable continuous sutures, if absorbable materials has been used before, can be undertaken.

Inguinal hernia repair. The Nyhus posterior preperitoneal operation.

It is probably best performed with the patient receiving regional or general anesthesia. A hernia is an outpouching of the parietal peritoneum through a preformed or secondarily established hiatus. These can be performed using an open approach or nyus with an anterior or posterior approach. This book is recommended for both the novice and the well-established general surgeon.

Type III—posterior wall defects. Studies conducted at nonspecialty centers probably provide a more accurate view of hernia repair techniques and results.

Nyhus and Condon’s Hernia

Another section is devoted exclusively to the options of hernia repair. The first anatomical studies of the inguinal region date back to Galen — A. Systemic comorbidity, such as obesity, steroid use and chronic obstructive pulmonary disease, ehrnia wound healing and can affect the recurrence rate.

Dilated internal inguinal ring with posterior inguinal wall intact. The disappointing results after repetition of the primary failing techniques recommends a change of technique. Please review our privacy policy. Reasons for an acute elevation of the intra-abdominal pressure include ascites from cirrhosis, congestive heart failure or nephrosis.

Sonography may be useful in diagnosing inguinal hernias hernoa patients who report symptoms but do not have byhus palpable defect. Inguinal hernia repair in adults.


Inguinal hernia repair using local anaesthesia. Depending on the patients condition, there are some typical patient-related risk factors, such as arteriosclerosis and diabetes mellitus, that may lead to a local reduction of blood supply, causing a reduction of wound oxygenation and nutrition. Clear Turn Off Turn On.

Nyhus and Condon’s Hernia | JAMA Surgery | JAMA Network

More in Pubmed Citation Related Articles. Some concern exists about the long-term safety of implanted prosthetic material, particularly the potential for infection or erosion. But changes in the contents lead more commonly to the hernia’s becoming a true disease entity. Preperitoneal mesh-implantation was first described by Rives for unilateral hernias and by Stoppa for bilateral inguinal hernias. Information from references 7and 15 through An indirect hernia is generally believed to have a congenital component.

Average of 3 years, with a range of 1 to 5 years. Privacy Policy Terms of Use. Some state health plans do not reimburse for elective hernia repairs. In most studies an herniw of the infection rate was not shown, but recently nhhus development of late abscesses are reported. Transabdominal preperitoneal laparoscopic repair. The diagnosis of recurrent herniation is generally straightforward. In this circumstance, preperitoneal fat can protrude through the femoral ring, with its accompanying pelvic peritoneum.

With the many techniques available, treatment can be individualized. In the managed-care environment, elective herniorrhaphy is under increasing pressure.