What equipment is needed for an open inguinal hernia repair?

Updated: Jan 17, 2018
  • Author: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS; Chief Editor: Kurt E Roberts, MD  more...
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Answer

No special equipment is required for inguinal hernia repair. Standard operating room anesthesia equipment, outfitted for possible conversion to general anesthesia and endotracheal intubation, is required. For high-risk patients with comorbid conditions, a cardiac monitor and a pulse oximeter should be available.

A standard open surgical tray should be available. Instruments and materials on hand may include the following:

  • Syringe
  • 25-Gauge needle
  • Surgical knife with blade
  • Mosquito forceps
  • Dissecting scissors
  • Polypropylene (Prolene) or polyester mesh
  • Langenbeck retractors
  • Adson thumb forceps
  • Needle holder
  • Sutures (absorbable or nonabsorbable)
  • Penrose drain or umbilical tape
  • Noncrushing intestinal clamps (in case bowel resection is required, in a strangulated hernia)

A self-retaining (eg, Adson) retractor, though not essential, may eliminate the need for an assistant. The umbilical tape or Penrose drain may be used to retract the mobilized spermatic cord, but a hernia ring forceps can also be used. If the neck of the hernia sac is particularly tight, the use of a grooved probe or dissector may help minimize injury to the contents.

The mesh must be a permanent material large enough to produce a wide overlap beyond the defect’s edges (eg, 5 × 10 cm to 7.5 × 15 cm). Many manufacturers have now shifted toward lighter, more porous constructions that maintain the strength of the repair but putatively reduce the inflammatory response. [11, 42, 43, 44, 45] These meshes may decrease long-term discomfort, but possibly at the cost of increased recurrence rates (eg, from inadequate fixation or overlap). [5]

The question of absorbable versus permanent sutures to secure the mesh is based on surgeon preference; to date, there has been no evidence conclusively favoring one type over the other. Sutures made of polyglactin or polypropylene are commonly used, with undyed polyglactin often preferred for subcutaneous tissue. A theoretical advantage of absorbable suture is that if nerve impingement is inadvertently caused, the suture material disappears with time. The authors prefer to use absorbable (2-0 polyglactin) sutures for mesh fixation.


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