What causes abdominopelvic structure injuries in 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

Cord structures (eg, testicular artery, pampiniform plexus of veins, and vas deferens) may be injured during opening of the coverings of the spermatic cord or dissection of the indirect hernial sac within the spermatic cord. In particular, the surgeon should always be aware of the vas deferens and should protect it from injury.

Injury to the urinary bladder may occur during plication of the transversalis fascia. In addition, injury to the urinary bladder, cecum, or sigmoid colon may occur during transfixion of the hernial sac in a sliding indirect inguinal hernia (where these viscera are not contained in the hernial sac but form a part of the wall of the sac). A sliding hernia should be recognized early; if it is present, the entire hernial sac should not be excised.

Injury to the bowel may occur during transfixion of the neck of an indirect hernial sac. The head end of the operating table can be lowered to ensure complete reduction of contents of the sac, the sac can be twisted to push the contents into the peritoneal cavity, and a tissue bite can be taken and the suture tied under vision.


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