Tension-free hernia repair surgical procedure steps
Nov 17, 2022
Source: Cainiu Health
Dr. Sun Shaolong
Introduction
The main steps of tension-free hernia repair surgery include anesthesia, incision, dissection of the hernial sac, resection of herniated contents, separation of the spermatic cord, and closure of the hernial defect. This method overcomes the disruption of normal anatomical structures associated with traditional surgery, features clear tissue layers, and ensures a tension-free repair in the surrounding tissues, hence the name "tension-free hernia repair."
The main steps of tension-free hernia repair surgery include anesthesia, incision, dissection of the hernial sac, resection of herniated contents, separation of the spermatic cord, and closure of the hernia defect. The specific procedural steps are as follows:
1. After administering combined spinal-epidural anesthesia, the patient is placed in a supine position. Routine skin and instrument disinfection is performed, and sterile drapes are applied over the inguinal region.
2. A skin incision is made approximately 2 cm above the inguinal ligament, starting slightly lateral to the midpoint of the inguinal ligament and extending obliquely toward a point just above the pubic tubercle, running parallel to the inguinal ligament. The skin and subcutaneous tissue are cut through to expose the silvery-white external oblique aponeurosis and the external ring.
3. Using toothed forceps, the external oblique aponeurosis is lifted. A curved hemostat is used to carefully dissect the deeper tissues, gently pushing aside the ilioinguinal nerve lying beneath the aponeurosis. A straight scissors is then used to cut the aponeurosis along its fiber direction. The two flaps of the aponeurosis are subsequently separated and retracted bluntly.
4. Retractors are used to pull aside the ilioinguinal nerve, external and internal oblique muscles, transversus abdominis muscle, and their conjoint tendon to fully expose the cremaster muscle. The cremaster muscle is split along its fibers to reveal the hernial sac. The surgeon gently lifts the hernial sac with toothed forceps, while the first assistant grasps another point on the sac about 0.5 cm away. An incision is made between these two points to open the sac.
5. Hemostats are used to grasp the edges of the opened hernial sac. Preoperatively, the surgeon's left hand lifts the sac while inserting the left index finger behind it to support the sac wall. The right index finger, wrapped in saline-soaked gauze, performs blunt dissection to separate the hernial sac from surrounding tissues and the spermatic cord.
6. The neck of the hernial sac is completely freed in one piece, then cut horizontally at mid-level, dividing the sac into proximal and distal portions. The sac is pulled circumferentially with hemostats, and all contents within the sac are reduced back into the abdominal cavity. Finally, silk sutures are used to perform a full-thickness ligation at the neck of the hernial sac.
