Surgical Technique (Inguinal Hernia)

swel_34a_n.jpg - swel_34i_n.jpg: Steps of herniotomy in childhood. This demonstration is not to be regarded as an advice for pediatric surgeons. Rather, it is to show the student, the pediatric surgeon in training, the general practitioner, the pediatrician, and other interested people what ideas are adhered to in such a frequent intervention. swel_34a_n.jpg: Skin incision above the groin in a skin fold. swel_34b_n.jpg: Stepwise preparation of the superficial fascia with a minimal loss of blood and therefore, avoiding wound hematoma as a forerunner of wound infection. In the figure the epigastric vessels are visible. swel_34c_n.jpg: Preparation of the external inguinal ring and incision of the external aponeurosis using a tweezer introduced into the inguinal channel. swel_34d_n.jpg: Preparation of the inguinal channel: The external aponeurosis is split; preparation of the lower border of the internal abdominal muscle which has a variable level and of the inguinal ligament lying underneath the caudal border of the external aponeurosis with a swab. swel_34e_n.jpg: Following incision of the cremasteric fascia and muscle fibers, the vessels of the spermatic cord (yellow restraint) and the vas deferens (green restraint) are isolated, and the hernia sac is visualized in its whole length lying in front of these structures. swel_34f_n.jpg: The isolated hernia sac is palpated (in girls regularly opened for inspection of the adnex), ligated at the inner inguinal ring, and resected close to the point of ligature. In the picture the hernia sac is held by a forceps in a cranial direction and the structures of the spermatic cord toward the bottom. swel_34g_n.jpg: Reconstruction, first part: A secondary direct inguinal hernia is avoided by a suture of the lower border of the internal abdominal muscle to the inside of the inguinal ligament (Girard's procedure). swel_34h_n.jpg: Reconstruction, second part: Closure of the external aponeurosis without embarrassment of the course and without constriction of the spermatic cord. swel_34i_n.jpg: Wound closure: Only a single suture closes the Scarpi fascia which was distinctly defined during the preparation of the superficial fascia. Closure of the skin with an intracutaneous suture of an absorbable or non-absorbable thread, and final evaluation of correct site of the testicles within the scrotum by palpation.