Lotheissen-McVay hernia repair
Lotheissen-McVay Hernia Repair: Overview and Outcomes
Introduction
- Origin: First introduced by Austrian surgeon Georg Lotheissen and later popularized by American surgeon Chester McVay.
- Purpose: Used to treat femoral and inguinal hernias, including recurrent ones.
Technique
- Approach: The hernia is accessed through the inguinal canal (Lotheissen’s operation).
- Hernioplasty Method: Suturing the transversal fascia to various anatomical landmarks, including the tendon conjoint, pectineal ligament, and tuberculum pubicum (McVay’s technique).
Complications
- Primary Operation Complications: Include hematoma and seroma (4.4%), wound infections (1.7%), pulmonary embolism (0.9%), deep vein thrombosis (0.7%), and testicular atrophy (0.4%).
- Comparison with Other Techniques: Does not exhibit higher complication rates compared to other hernia repair methods.
Recurrence Rates
- Influence of Follow-Up Time and Surgeon Experience:
- For primary hernias, recurrence rates vary from 0.7% after 1 year to 11.5% after 15 years.
- Lower recurrence in operations by experienced surgeons (3.6%) compared to inexperienced surgeons (16.3%).
Recovery and Postoperative Care
- Return to Work: Generally, after 2 or 3 weeks.
- Activity Restrictions: Avoidance of heavy lifting and strenuous activities for about 6 weeks.
- Gradual Resumption of Normal Activities: Based on comfort and absence of discomfort.
Conclusion
The Lotheissen-McVay technique is a well-established and effective method for the treatment of inguinal and femoral hernias. Its success, however, is contingent on the experience of the surgeon and adherence to postoperative care guidelines. Patients undergoing this procedure can expect a standard recovery period and a relatively low recurrence rate, especially under the care of experienced surgeons.
Lotheisen-McVay Hernia Repair Technique: Detailed Procedure
Principle
- Modification of McVay Technique: The Lotheisen-McVay method adapts the original McVay technique, which involved suturing the transversalis fascia and transversus abdominis to the pectineal ligament (Cooper’s ligament).
- Triple Layer Adaptation: This modified technique involves suturing the transversalis fascia, transversus abdominis muscle, and internal oblique muscle to the pectineal ligament, providing a secure closure of both the femoral and inguinal canals.
- Rectus Sheath Incision: An incision of the rectus sheath is necessary due to high suture tension caused by the distance between suture sites.
Surgical Procedure
- Transversalis Fascia Incision: An incision is made in the transversalis fascia, followed by the retraction of preperitoneal fat tissue dorsally.
- Exposure of Key Structures: In the medial wound angle, the lacunar ligament, the superior pubic ramus, and the pectineal ligament running over it are exposed.
Cautions
- Avoiding Vascular Injury:
- Care must be taken not to damage the large anastomosis between the obturator artery and the inferior epigastric artery (“Corona mortis”), which can lead to severe bleeding.
- The femoral vessels, located laterally in their sheath, must be carefully displaced to the side with a hook.
- Suturing Process:
- First Suture: Placed through the triple layer in the medial wound angle.
- Lower Sutures: These grasp the lacunar ligament and the periosteum of the pubic tubercle.
- Suture Material: A monofilament, heavy or non-resorbable suture of size 2-0, armed with a clamp.
- Subsequent Sutures: Continuing laterally, these sutures grasp the triple layer cranially and the pectineal ligament and caudal edge of the transversalis fascia caudally.
- Final Suture (“Transition Stitch”): Goes through the femoral sheath caudally.
Further Cautions
- Ensuring Vascular Safety: Strict attention is required to prevent injury or constriction of the femoral vessels.
- Completing the Operation:
- Knotting the Sutures: The armed sutures are individually tied from medial to lateral.
- Closure of External Oblique Aponeurosis: Performed over the spermatic cord along with the reconstruction of the external inguinal ring.
- Wound Closure: Mandatory to complete the procedure.
Conclusion
The Lotheisen-McVay hernia repair is a comprehensive, meticulous surgical technique that emphasizes careful suturing and attention to vascular structures. Its effectiveness in securely closing both femoral and inguinal hernias makes it a valuable method, but its success depends on the surgeon’s expertise and adherence to these intricate steps.
Lotheissen-McVay Hernia Repair: Complications and Recovery
Complications Overview
- Primary Operation Complications: Include hematoma and seroma (4.4%), wound infections (1.7%), pulmonary embolism (0.9%), deep vein thrombosis (0.7%), and testicular atrophy (0.4%).
- Comparison with Other Techniques: The complication rates are comparable to, or not significantly higher than, those associated with other hernia repair methods, such as the Lichtenstein Open Repair and Laparoscopic Transabdominal Pre-peritoneal (TAPP) Repair.
Importance of Surgeon Experience
- Impact on Recurrence Rate: The surgeon’s experience crucially influences the procedure’s outcome. Experienced surgeons show a lower recurrence rate (3.6%) compared to less experienced surgeons (16.3%).
Recovery Process
- Return to Work: Patients typically resume work within 2 to 3 weeks post-surgery.
- Activity Limitations: Heavy lifting and strenuous activities should be avoided for about 6 weeks.
- Resumption of Normal Activities: Patients are advised to gradually return to their usual activities, based on their comfort and ability to perform them without discomfort.
Conclusion
The Lotheissen-McVay technique is a viable option for femoral and inguinal hernia repairs, with complication rates on par with other established methods. A key factor in successful outcomes, particularly in reducing recurrence rates, is the experience of the surgeon performing the procedure. Postoperative recovery is generally straightforward, allowing patients to return to normal activities following a brief period of rest and activity limitations.
Lotheissen-McVay Hernia Repair: Overview and Outcomes
Introduction
- Origin: First introduced by Austrian surgeon Georg Lotheissen and later popularized by American surgeon Chester McVay.
- Purpose: Used to treat femoral and inguinal hernias, including recurrent ones.
Technique
- Approach: The hernia is accessed through the inguinal canal (Lotheissen’s operation).
- Hernioplasty Method: Suturing the transversal fascia to various anatomical landmarks, including the tendon conjoint, pectineal ligament, and tuberculum pubicum (McVay’s technique).
Complications
- Primary Operation Complications: Include hematoma and seroma (4.4%), wound infections (1.7%), pulmonary embolism (0.9%), deep vein thrombosis (0.7%), and testicular atrophy (0.4%).
- Comparison with Other Techniques: Does not exhibit higher complication rates compared to other hernia repair methods.
Recurrence Rates
- Influence of Follow-Up Time and Surgeon Experience:
- For primary hernias, recurrence rates vary from 0.7% after 1 year to 11.5% after 15 years.
- Lower recurrence in operations by experienced surgeons (3.6%) compared to inexperienced surgeons (16.3%).
Recovery and Postoperative Care
- Return to Work: Generally, after 2 or 3 weeks.
- Activity Restrictions: Avoidance of heavy lifting and strenuous activities for about 6 weeks.
- Gradual Resumption of Normal Activities: Based on comfort and absence of discomfort.
Conclusion
The Lotheissen-McVay technique is a well-established and effective method for the treatment of inguinal and femoral hernias. Its success, however, is contingent on the experience of the surgeon and adherence to postoperative care guidelines. Patients undergoing this procedure can expect a standard recovery period and a relatively low recurrence rate, especially under the care of experienced surgeons.
Lotheisen-McVay Hernia Repair Technique: Detailed Procedure
Principle
- Modification of McVay Technique: The Lotheisen-McVay method adapts the original McVay technique, which involved suturing the transversalis fascia and transversus abdominis to the pectineal ligament (Cooper’s ligament).
- Triple Layer Adaptation: This modified technique involves suturing the transversalis fascia, transversus abdominis muscle, and internal oblique muscle to the pectineal ligament, providing a secure closure of both the femoral and inguinal canals.
- Rectus Sheath Incision: An incision of the rectus sheath is necessary due to high suture tension caused by the distance between suture sites.
Surgical Procedure
- Transversalis Fascia Incision: An incision is made in the transversalis fascia, followed by the retraction of preperitoneal fat tissue dorsally.
- Exposure of Key Structures: In the medial wound angle, the lacunar ligament, the superior pubic ramus, and the pectineal ligament running over it are exposed.
Cautions
- Avoiding Vascular Injury:
- Care must be taken not to damage the large anastomosis between the obturator artery and the inferior epigastric artery (“Corona mortis”), which can lead to severe bleeding.
- The femoral vessels, located laterally in their sheath, must be carefully displaced to the side with a hook.
- Suturing Process:
- First Suture: Placed through the triple layer in the medial wound angle.
- Lower Sutures: These grasp the lacunar ligament and the periosteum of the pubic tubercle.
- Suture Material: A monofilament, heavy or non-resorbable suture of size 2-0, armed with a clamp.
- Subsequent Sutures: Continuing laterally, these sutures grasp the triple layer cranially and the pectineal ligament and caudal edge of the transversalis fascia caudally.
- Final Suture (“Transition Stitch”): Goes through the femoral sheath caudally.
Further Cautions
- Ensuring Vascular Safety: Strict attention is required to prevent injury or constriction of the femoral vessels.
- Completing the Operation:
- Knotting the Sutures: The armed sutures are individually tied from medial to lateral.
- Closure of External Oblique Aponeurosis: Performed over the spermatic cord along with the reconstruction of the external inguinal ring.
- Wound Closure: Mandatory to complete the procedure.
Conclusion
The Lotheisen-McVay hernia repair is a comprehensive, meticulous surgical technique that emphasizes careful suturing and attention to vascular structures. Its effectiveness in securely closing both femoral and inguinal hernias makes it a valuable method, but its success depends on the surgeon’s expertise and adherence to these intricate steps.
Lotheissen-McVay Hernia Repair: Complications and Recovery
Complications Overview
- Primary Operation Complications: Include hematoma and seroma (4.4%), wound infections (1.7%), pulmonary embolism (0.9%), deep vein thrombosis (0.7%), and testicular atrophy (0.4%).
- Comparison with Other Techniques: The complication rates are comparable to, or not significantly higher than, those associated with other hernia repair methods, such as the Lichtenstein Open Repair and Laparoscopic Transabdominal Pre-peritoneal (TAPP) Repair.
Importance of Surgeon Experience
- Impact on Recurrence Rate: The surgeon’s experience crucially influences the procedure’s outcome. Experienced surgeons show a lower recurrence rate (3.6%) compared to less experienced surgeons (16.3%).
Recovery Process
- Return to Work: Patients typically resume work within 2 to 3 weeks post-surgery.
- Activity Limitations: Heavy lifting and strenuous activities should be avoided for about 6 weeks.
- Resumption of Normal Activities: Patients are advised to gradually return to their usual activities, based on their comfort and ability to perform them without discomfort.
Conclusion
The Lotheissen-McVay technique is a viable option for femoral and inguinal hernia repairs, with complication rates on par with other established methods. A key factor in successful outcomes, particularly in reducing recurrence rates, is the experience of the surgeon performing the procedure. Postoperative recovery is generally straightforward, allowing patients to return to normal activities following a brief period of rest and activity limitations.