Inguinal hernia repair, Rutkow Plug

Anatomy Perioperative management Technique Complications Evidence Total Video

Content

Authors

Dr. med. Karl Heinz Moser

Chirurgische Praxis

Date

surgery report

Principle

The Rutkow principle of inguinal hernia repair involves the insertion of an umbrella-like mesh plug into the local defect beneath the transversalis fascia. A second flat mesh, the onlay patch (similar to the Lichtenstein principle), is placed over the plug.
Inguinal skin incision

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A skin incision approximately 4 cm long is made obliquely 2 fingerbreadths above the inguinal ligament (solid line) or alternatively a transverse skin incision 2 fingerbreadths above the pubic bone. Subsequently, the subcutis is incised down to the external aponeurosis.
Splitting of the external aponeurosis

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The external aponeurosis is opened parallel to the fibers, including the external inguinal ring. The fascial edges are clamped, elevated, and the fascia is bluntly separated from the internal oblique muscle and the cremaster muscle.
Attention: The iliohypogastric nerve lies on the internal oblique muscle!