- All operable femoral hernias; indication relative in patients with impaired operability
- Emergency surgery in incarcerated femoral hernia
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Indication
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Contraindications
- Generally inoperable patients
- Local inoperability, e.g., due to: abdominal wall infection, tumor, aneurysm
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Preoperative diagnostic work-up
History
• General risk factors
• Underlying disorders of abdominal cavity (e.g., peritoneal carcinosis)
• Particular complaints, particular physical strain (e.g., sports)
• Infected inguinal region
• Previous inguinal surgery (recurrent hernia)
Examination
• General physical examination ascertaining operability
• Special abdominal examination
• Special examination of inguinal region
• Assessment of skin and soft tissue condition
• Possibly ultrasound study of abdominal wall / cavity
• Possibly classification of hernia (e.g., for scientific purposes)
Differential diagnosis
• Other masses: Lymphadenitis, lipoma, varicose nodules, tumors, etc.
• Other causes of pain: Groin strain, adductor tendinopathy, nerve irritation etc.
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Special preparation
- Mark the side of the hernia
- Single-shot administration of 2nd generation cephalosporin before local anesthesia or induction of general anesthesia
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Informed consent
General risks
Intraoperative:
• Bleeding
• Injury, e.g., to nerves, vessels, bowel, bladder
Postoperative:
•Secondary bleeding, hematoma
• Seroma
• Thrombosis and embolism
• Intestinal passage (atony, ileus)
• Secondary healing
• Infection and abscess
Special risks
•Chronic pain
• Foreign body reaction
• Mesh migration
• Mesh infection
• Mesh rupture
• Recurrent hernia
General anesthesiaLaryngeal mask airwaySpinal anesthesiaLocal anesthetics in inguinal hernia repair
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