Academic literature on the topic 'Inguinal bladder hernia'

Laparoscopic inguinal herniorrhaphy was initially described by Ger in the early 1980s. Nowadays, two techniques are worldwide adopted: the transabdominal preperitoneal approach (TAPP) and the totally extraperitoneal approach (TEP). In these repairs, the myopectineal orifice is approached posteriorly and allows for inguinal, femoral, and obturator hernia repairs to be performed simultaneously. TEP is a relatively new technique. McKernan and Law first introduced TEP in 1993. Some proponents of TEP advocate for this technique over the transabdominal approach due to the shorter operative times, especially for bilateral hernias, and decrease the risks of vascular, bowel, and bladder injuries as well as bowel obstructions, adhesions, or fistula formation potentially associated with intraperitoneal dissection and intraperitoneal mesh exposure. When compared with open hernia repair, and in particular for recurrent (after open) and bilateral hernias, many surgeons prefer the laparoendoscopic approach due to quicker recovery times and less postoperative and chronic pain. In experienced hands, there are no absolute contraindications to TEP, although a careful decision should be made to tailor the approach to both patient and surgeon factors. In this chapter, we will describe the technical steps of totally extraperitoneal hernia repair, the potential complications, and troubleshooting when needed.

This chapter addresses deficiencies in pre-anaesthesia communication. Here, the use of medical narrative illustrates communication-enhancing techniques and attitudes that may help anaesthetists anticipate and respond to the biopsychosocial content, extant in the pre-anaesthesia assessment setting. By any measure, the pre-anaesthesia evaluation sets anaesthesia care in motion. Until now, little has been written about the development of a learnable framework for effective communication, in this or any other anaesthesia care setting. With respect to pre-anaesthesia communication, the need for heuristics or ‘rules of thumb’ is ever acute to improve rapport, elicit and respond to questions, manage ambiguity, as well as to obtain valid consent. Furthermore, anaesthetists have to communicate effectively with patients about conflicting advice, prior negative anaesthetic experiences and fears about awareness and intraoperative death. A 56-year-old man scheduled for an elective left inguinal herniorrhaphy meets his anaesthetist minutes before surgery is to begin. Three days before, the patient presented to hospital with his hernia incarcerated. It was easily reduced. A follow-up office visit with his surgeon preceded the surgery. The patient’s sole co-morbidity is benign prostatic hypertrophy. On the morning of surgery this otherwise healthy-appearing man, accompanied by his wife, meets the anaesthetist for the first time. After record review the patient is told three anaesthetic options exist—local anaesthesia with intravenous sedation, general anaesthesia and spinal anaesthesia — and that ‘spinal is the way to go’. Unquestioningly, the patient agrees to spinal anaesthesia. The spinal block is easy to place. The surgery is uneventful. Post-operatively, the patient cannot urinate. His discharge from the day-surgery unit is delayed by hours. He is told it is because of ‘the spinal’. Bladder catheterization ensues. The rest of his recuperation is uneventful, except for lingering feelings of betrayal, distrust and disappointment. He wonders why he was not told spinal anaesthesia might cause urinary retention. He becomes angry. He resolves never to use that anaesthetist’s or hospital’s services again. His wife even urges him to sue them both for pain and suffering. What could have been done to effect a more positive outcome for the patient, the anaesthetist and the hospital? The answer lies, at least in part, in improved communication.