Mayo stand and back table instruments for Inguinal Hernia Repair surgery setup

Clamping & Occluding

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  Curved Hemostat

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  Right Angle Clamp

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  Tonsil Clamp

Cutting & Dissecting

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  #3 Knife Handle

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  Metzenbaum Scissor

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  Straight Mayo Scissor

Grasping & Holding

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  Adson Forceps

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  Debakey Forceps

Retracting & Exposing

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  Freeman Rake

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  Weitlaner Retractor

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  Army-Navy Retractor

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  Senn Retractor

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  Richardson Retractor

Suctioning

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  Yankauer Suction

Suturing & Stapling

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  Ryder Needle Holder

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  Mayo-Hegar Needle Holder

What to expect during Inguinal Hernia Repair

During an Inguinal Hernia Repair, the patient will be draped using 4 towels held together with either towel clamps or staples, and either a laparotomy drape, or a universal drape.

Cautery and suction will need to be passed off to be used during the case. Some surgeons do not want a suction thrown off because they don’t think they will need it. I always keep one at least in the room, just in case. It usually ends up being opened.

The doctor will make an oblique incision above the inguinal ligament with a 15 blade loaded on a #3 knife handle, and they will dissect to the hernia using their bovie, metz scissors, hemostats, adsons, and debakey forceps. Usually weitlaners, army-navy’s, and a variety of sized Richardson retractors are used.

This surgery is mainly a lot of dissecting with the bovie, DeBakeys, and Metz, and visualizing landmarks. They usually don’t take a long time though – around 1-1.5 hours.

A Penrose drain that has been wet with saline will be used to hold back the cord for easy identification, using a Kelley to clamp it to the drape so no one has to hold it. The vas deferens is located as well, and care is taken to not damage it.

Once the hernia sac has been freed, it can either be sent as a specimen, or be considered trash. It will be a flabby piece of tissue that doesn’t really look like anything. Ask the doctor if you aren’t sure what they just handed you, or threw on your Mayo stand like they usually do saying, “here’s your present”… so predictable. It is usually sent to pathology unless your surgeon is conscious of how much it will cost the patient.

Usually a piece of mesh is placed around the cord, and will be sutured into place using a medium sized needle driver and commonly 0 or 3-0 Prolene, debakey forcep (since it’s delicate tissue), and straight suture scissors. Sutures will be placed all along the mesh so there aren’t any gaps where the hernia could come back through.

The incision will then be closed in layers. The deepest layer is usually closed with an absorbable suture, like 3-0 Vicryl, and the skin is closed with either a 3-0 or 4-0 Nylon or Monocryl.

For dressings, skin glue is applied onto the incision site, and a dressing sponge topped with a Tegaderm or Opsite will be used to hold it in place. Always make sure the glue is completely dried before applying anything on top. Some surgeons prefer to only use glue.