Thursday, September 16, 2010

Inguinal hernia tissue repairs

McVay repair:
- for direct and femoral hernias
- transversalis aponeurosis and fascia sutured laterally to Cooper's ligament.
- sutures are placed beginning medially at the pubic tubercle and extending as far laterally as the femoral vein
- next suture (transition stitch) placed deeply into the pectineus fascia and more laterally through the anterior layer of the femoral sheath
- if conjoined to coopers stitches carried out too far lateral before transition stitch then patient can get femoral vein thrombisis
- treatment of femoral vein thrombosis involves anti-coagulants, recanalization and collateral venous formation usually occurs

Condon Repair:
- anterior approach similar to McVay repair but you are suturing the conjoined tendon to coopers and to iliopubic tract/poupart's ligament
- ?higher risk of femoral vein compression
- double closure of femoral canal
- but does this neccessarily add anything beyond a McVay repair?

Nyhus repair:
- Preperitoneal approach to hernia repair
- from posteriorly similar to a condon repair you close femoral canal by suturing iliopubic tract to cooper's ligament

Poupart's ligament is the reflection of the external oblique aponeurosis
iliopubic tract extends from ASIS to the pubic tubercle

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