股疝修补术【英文讲义】

Femoral hernia repair

                               
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Femoral hernia repair

Definition

A femoral hernia repair or herniorraphy is really a surgical treatment carried out to reposition tissue which has emerged via a weak spot within the abdominal wall close to the groin. Generally, a hernia is really a protrusion of the loop or bit of tissue via a weak spot or opening within the abdominal wall. There are many different types of hernias; they're named based on their whereabouts. A femoral hernia is occurring inside a person's groin close to the thigh. Inside a child, a femoral hernia is generally caused by imperfect closing of the area during rise in the womb.

Purpose

Femoral hernia repair is performed to lessen the patient's risk of the future surgical emergencies. A hernia might be congenital or may create later in everyday life due to a weakness within the abdominal wall. When the opening is extremely small, the quantity of tissue that may precede it's small, and also the person may seldom be familiar with the issue. One problem that could occur, however, would be that the tissue that arrives with the opening may become incarcerated, or caught. When the herniated tissue has its own circulation reduced due to pressure from other nearby organs or structures, it's known as strangulated. Strangulation can lead to gangrene, meaning the impacted tissue can die and become invaded by bacteria. Femoral hernias are more inclined than other hernias being incarcerated or strangulated since the impacted tissue pushes via a relatively small, closely limited space. Due to the greater risk of eventual strangulation and gangrene, the patient's physician may suggest surgical repair of the hernia.

Demographics

Femoral hernias really are fairly uncommon type, comprising only 3% of hernias. While femoral hernias may appear both in men and women, the majority of them create in females due to the wider bone framework from the female pelvis. Femoral hernias generally grow larger with time; any action which involves straining, for example heavy-lifting or perhaps a chronic cough, could cause the hernia to expand. Poor abdominal tone of muscle, obesity, and pregnancy may also increase a ladies risk of creating a femoral hernia. Most femoral hernias create on just one side from the patient's abdomen, but about 15% of femoral hernias are bilateral. These bilateral hernias may become strangulated. One more 20% of femoral hernias become incarcerated.

Femoral hernias tend to be more common in grown-ups compared to children. The ones that do exist in youngsters are prone to be of a ligament disorder or with problems that increase intra-abdominal pressure. 70 % of pediatric cases of femoral hernias exist in infants younger than one.

Who performs the process and where could it be carried out?

This process is conducted with a general doctor. Just like any procedure, the greater go through the doctor has using the particular surgery being carried out, the greater the expected outcome. A femoral hernia repair is generally carried out with an outpatient, or ambulatory, basis inside a hospital. After a couple of hours of recovery within the surgical center, the individual has the capacity to return home.

Description

Femoral hernia repair might be carried out under either general or local anesthesia. The repair from the hernia entails a cut, or incision, within the groin area, next to the femoral artery. The doctor finds the hernia, and lowers it by pushing the protruding tissue back within the abdominal cavity. A hernia is called reducible once the tissue which has emerged with the opening could be pushed back and also the opening closed. If incarceration or strangulation has taken place, the hernia is called irreducible.

The process might be carried out while using traditional open method, which takes a larger surgical incision, or with a laparoscopic approach. A laparoscopic process is conducted via a few really small incisions. The outlet within the abdominal wall might be closed with sutures, or through an excellent sterile surgical mesh. The mesh, which supplies further strength, is sewn to the abdominal wall with actually small stitches. Some doctors might want to make use of the mesh when repairing a bigger hernia. A hernia repair completed with a mesh insert is known as tension-free procedure since the doctor doesn't have to place tension about the layer of muscle tissues to be able to bring the perimeters from the hole together. A laparoscopic hernia repair requires about 40 minutes accomplishing.

Questions a patient should ask a doctor

• Who can be a suitable applicant for laparoscopic surgery?
• How long is a patient’s recovery prone to take?
• What limitations maybe there is on a patient’s day to day activities, for example going back to work, driving, or lifting child?
• How many femoral hernia repairs perhaps doctor has carried out?
• How many femoral hernia repairs perhaps doctor has carried out having a laparoscope?
• What types of problems have doctor’s patients experienced?
  

Preparation/Diagnosis

Preparation

When the physician suspects how the hernia is strangulated, she or he can give the individual a broad-spectrum antibiotic intravenously prior to the patient comes to the operating room. Adults appointed for any nonemergency herniorraphy receive standard blood tests along with a urinalysis. They ought to not eat breakfast at the morning from the procedure, plus they should wear loose-fitting, comfortable clothing that they'll easily pull on following the surgery without the need of straining their abdomen.

Diagnosis

A femoral hernia is generally diagnosed throughout a physical evaluation. Oftentimes, the individual will consult a doctor due to pain within the groin area or even the within the upper thigh. The pain sensation or pain of the femoral hernia will come and go, increasing once the person coughs or strains. When the pain is extreme, the individual might have to go for an emergency room. In young kids, the signs of an incarcerated femoral hernia consist of serious irritability, abdominal pain, cramping, and vomiting. Adult patients might have also felt full of within the groin which may be tender when it's pressed. Patients in serious pain might be given a sedative or pain-killing medicine so the physician can look at the groin area and then try to advice the herniated tissues back with the abdominal opening with gentle manual pressure.

In adult patients, a doctor will eliminate the chance that the pain sensation is brought on by an increased lymph node, a lipoma, or an inguinal hernia. Imaging studies aren't normally utilized in diagnosing a hernia unless a doctor suspects how the hernia is incarcerated or strangulated. A strangulated hernia could be recognized from an incarcerated hernia through the existence of fever; pain that persists following the physician has decreased the hernia manually; and pain that's worse than warranted through the examination findings.

Risks

All surgical treatments have connected risks, both surgical and anesthesia-related. Bleeding and infection would be the two primary surgical risks. The chance of infection to have a straightforward femoral hernia repair is all about 1%. Anesthesia-related risks include reactions towards the anesthetic agents, including interactions with over-the-counter and herbal preparations, in addition to potential respiratory problems. There's a small risk of recurrence of the femoral hernia. Additionally, female patients are in some injury risk towards the nerves and circulation of the reproductive organs, because femoral hernias acquire inside a part of the main abdominal wall that's near to the uterus and ovaries.

Morbidity and mortality rates

The mortality rate following a simple femoral hernia repair is basically zero. The mortality rate for repair of the strangulated hernia which has necessitated a bowel resection is higher, however, which range from 5-19%. Morbidity following a simple herniorraphy is low. The occurrence of postoperative swelling and bruising was 8%.

Normal results

Normal results with regular diagnosis and repair of the femoral hernia really are a smooth recovery without any recurrence from the hernia.

Aftercare

Aftercare depends upon a number of factors: the patient's age and overall health status; the kind of surgery (open or laparoscopic); and also the kind of anesthesia administered. Soon after the process, the individual is going to come to the recovery part of the surgical center and supervised for signs and symptoms of extreme bleeding, infection, uncontrolled pain, or shock. A simple femoral hernia repair is generally carried out with an outpatient basis that allows the individual to visit home inside a couple of hours from the surgery.

The individual will be presented instructions about incision care, that will rely on the kind of surgery and exactly how where the incision was closed. Sometimes a transparent dressing is positioned about the wound how the patient can remove around three days following the process. Really small incisions, for example those employed for laparoscopic surgery, might be closed with Steri-strips® rather than sutures. The incision ought to be kept dry, so patients should have a sponge bath rather than shower or tub bath for a few days after surgery.

Adults should avoid heavy-lifting for many weeks following a hernia repair. The doctor can provide the individual advice about particular weight limits on lifting. Contact sports and strenuous exercise ought to be avoided for around 3 weeks following a femoral hernia repair. Many patients can go back to the majority of their day to day activities a few weeks, with total recovery taking in regards to a month in patients without other health conditions.

Alternatives

There aren't any medical or surgical options to a femoral hernia repair apart from watchful waiting. There's some risk how the hernia will expand, however, which boosts the risk of incarceration or strangulation. Moreover, the problems and risks of surgery increase with incarcerated or strangulated hernias. When a hernia is suspected or diagnosed, it ought to be evaluated with a doctor inside a month to reduce the chance of complications.