Perioperative management - Rutkow plug repair in inguinal hernia - general and visceral surgery
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Indications
- Indirect hernia (Schumpelick L I-III)
- Direct hernia (Schumpelick M I-III)
- Femoral hernia (Schumpelick F I-III)
- Recurrent hernia (Schumpelick R I-III)
- Combined hernia (Schumpelick ML I-III)
Contraindications
- The same restrictions/recommendations for patients < 30 years as in the other surgical procedures with alloplastic meshes.
- Patients in endstage of a malignancy
- High-risk surgical patients
Preoperative diagnostic work-up
- Clinical examination
- Ultrasonography with 7.5 MHz probe with patient standing and supine to rule out hydrocele, malignancy (e.g., sarcoma), lipoma
Special preparation
- Marking the side of the hernia examined with the patient standing
- Reduce the potential of infection by shaving the surgical field just before the procedure is started
- 1/2 hour before skin incision a single-shot antibiotic regimen is recommended, e.g., with 2nd generation cephalosporin
Informed consent
- Seroma
- Mesh migration
- Chronic inflammation reaction
- Late-onset infection
- Mesh shrinkage by scar contraction
- Fistula
- Spermatic duct affections
Anesthesia
Positioning
Operating room setup
Special instruments and fixation systems
Postoperative management
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