Hernia, as a problem with the muscle tissue in the abdominal wall, is one of the health problems that can be treated. Divided in to three categories, hernia presents the following symptoms: pain when lifting, bulges under the skin or problems caused by long time standing or sitting. The three categories that we were talking about are inguinal hernia, umbilical hernia and incisional hernia.



The most common way to get rid of hernia is surgery. Contraindicated in some cases surgery is the most efficient method for treating hernia even though it does not guarantee that hernia will not occur again.

For a surgical intervention patients should be well prepared with some time before. Open mesh repair is one of the operative techniques in treating hernia. This intervention is done under local anesthesia. During this intervention all patients with hernia should have an intravenous cannula inserted. In the same time the patient's arms must be held in such a way that will not permit the patient to touch the operative field. Before operation surgeons must assure that a pulse oximeter, an automated blood pressure cuff and ECG electrodes are placed correctly. A nurse is responsible to watch closely the vital signs. The operating table must be tilted head down by about 15o.

Anesthesia is very important before starting the operation. The most common anesthesia used is the combination between lignocaine and bupivacaine because of its rapidity. The maximum dosage for a normal man of 70 kg is 280 mg which means not more than 4 mg/kg.

First of all the infiltration of lignocaine is done. A subcutaneous weal is raised to the iliac spine. Another one is raised two fingers breadth to this one. Through these two a 23 gauge spinal needle is inserted. Than 10 to 15 mg of lignocaine will be inserted along the line of incision. Just above the pubic tubercle another quantity of 5 mg of lignocaine is injected. The remaining 10 mg of lignocaine will be used later during the procedure. After these incisions an ilio-inguinal block will be caused by the usage of bupivacaine.

During the operation lignocaine is used for injecting two areas. The first area injected is the pubic tubercle and the second one is the peritoneum forming the base of the indirect sac. It is often use because of a fast response.

The skin incision will be placed above the inguinal ligament at about 1 cm distance, in order to extend to the deep ring.