Inspection:
lie falt
scars, abd scars or groin scars
cough impulse
reduce
ascites, chronic cough
Palpation
locate ASIS and pubic tubercle (trace adductor longus)
deep inguinal ring at 2cm above mid-point of inguinal ligt
control at deep inguinal ring
if controlled at deep ring, control at external ring (boundary of hasselbach's triangle is inferior epigastric vessels, inguinal ligt, rectus sheath
scrotal extension
abd examination
Per rectal examination
Mx:
look for cause of raised abdominal pressure
emergency and elective
lichtenstein tension free mesh repair
laparoscopic if recurrent, bilateral
spermatic cord
artery to vas
cremasteric artery
testicular artery
pampiniform plexus
vas deferens
lymphatics
genital branch of genitofemoral nerve
nerve to cremasteric muscle
ilioinguinal nerve (lies on top of spermatic cord)
complications
immediate
haemorrhage
nerve damage
spermatic cord damage
early
infection
slippage of mesh
pain
late
recurrance
pain
post-operative
lifestyle changes to decrease abdominal pressure (stool softeners, high fibre diet)
avoid heavy manual work ¬6 wks
