Home

High ligation hernia

To Address The Root Cause Not Just The Syptoms. Read More About Herb Search for do high hernia. Whatever You Need, Whatever You Want, Whatever You Desire, We Provide Conclusion: High ligation of the hernia sac in adolescents is effective and has an acceptable risk of recurrence while avoiding any additional morbidity that may come from the use of mesh. Patients with cardiac and gastrointestinal comorbidities should be counseled on the higher risk of recurrence High ligation of the inguinal hernia sac is standard practice for many pediatric surgeons in postpubertal adolescents. Most adult surgeons do not use this technique to repair indirect inguinal hernias because of concerns for higher recurrence rates compared with mesh repairs

High ligation of the hernia sac by either the classic open technique or more recent laparoscopic techniques remains the standard of care for pediatric indirect inguinal hernia The importance of freeing an indirect inguinal hernial sac or a peritoneal protrusion at the internal ring is discussed and emphasized. The technic at the internal ring used at the Shouldice Clinic is described. The justification for this technic lies in the results obtained. An analysis of more than 32,000 inguinal herniorrhaphies performed in.

A hernia occurs when there is a weakness or tear in muscle tissue and allows

Groin hernia 4th year

The second procedure, high ligation of the sac with plication of the floor of the inguinal canal (the transversalis fascia), is necessary when the hernia has repeatedly passed through the internal ring and has enlarged the ring, partially destroying and causing weakness in the inguinal floor Methods: A poll was posted on the International Hernia Collaboration Group Facebook page as well as the Facebook page for the authoring pediatric surgeon. The poll gave scenarios of a 16-year-old male with an inguinal hernia and asked surgeons to select one of five listed procedures to repair the hernia: high ligation (open or laparoscopic. STUDY DESIGN: This double randomized controlled trial compared high ligation and ring narrowing with Bassini-Stetten repair for the indirect inguinal hernia with a firm posterior wall, and Shouldice with Bassini-Stetten repair for the inguinal hernia with a weakened posterior wall, direct or indirect High ligation of an indirect hernia sac is performed and the spermatic cord structures are retracted inferiorly. The external oblique aponeurosis is separated from the underlying internal oblique muscle high enough to accommodate a 6- to 8-cm-wide mesh patch. Overlap of the internal oblique muscle edge by 2 to 3 cm is necessary Hernia sac exists as both a direct and indirect hernia straddling the inferior epigastric vessels and protruding through the floor of the canal as well as the internal ring (2 sacs separated by inferior epigastric vessels like a pair of pantaloon pants) High ligation. Ligation and transection of indirect hernia sac without repair of.

Conventional inguinal hernia repair in children involves ligation of the hernial sac at the internal inguinal ring. Laparoscopic surgery has been applied in children, and the repair is based on the same principle.1Laparoscopic repair has also been applied to direct2and recurrent3inguinal hernias Conclusions: In adolescents and young adults, the long-term recurrence rate after inguinal hernia repair is ∼6% with time to recurrence approaching 4 years. Outcomes of high ligation and mesh repair are similar, highlighting the need for individualized approaches for this unique population The spermatic cord is explored. If there is an indirect inguinal hernia sac present, then this is separated from the cord, and a high ligation is performed. Using the Penrose drain, the spermatic cord is retracted inferiorly out of the operative field. The inguinal floor can then be inspected. The floor of the inguinal canal is usually thin and.

If the internal ring is enlarged, the cord must be elevated from its bed with a soft rubber drain. A silk suture between the transversalis fascia and the inguinal ligament can be used to tighten.. A premature baby boy with bilateral giant inguinoscrotal hernias. Because of the large size of the hernias, operative repair typically requires repair of the inguinal floor in addition to the high.. High Ligation of Hernia Sac Narrowing of the Internal Inguinal Ring Later few others were added so as to bring down the recurrence rates and complications, reconstructing the posterior inguinal wall and tensionless repair were the fourth and fifth rules The modified Bassini repair involves high ligation of the hernia sac and reconstruction of the inguinal floor. It is performed for direct and indirect inguinal hernias, but has a higher rate of recurrence as compared to the Lichtenstein/mesh repair of inguinal hernia

Because of the large size of the hernias, operative repair typically requires repair of the inguinal floor in addition to the high ligation of the indirect hernia sac. View Media Gallery Read Mor Traditionally, high ligation of the hernia sac was performed to repair the congenital defect. This method was shown to cause unnecessary risks, detailed above. In females, this would normally entail dissecting the fallopian tube to separate it from the hernia sac High Ligation of the Hernia Sac and Internal Ring Repair. 5. Closure. jkl keys enabled. 823 views. Infant Right Open Inguinal Hernia Repair. Domingo Alvear, MD 1; Yoko Young Sang, MD 2 1 World Surgical Foundation 2 Louisiana State University Shreveport The classical open approach with high ligation of hernia sac has stood the test of time and is associated with a complication rate of less than 2% [52]. Bleeding ; Bleeding due to severing of small veins in superficial fascia may be a minor trouble and is generally easy to control

Get Proven Holistic Herbs · 30 Day Return Polic

Hernias2

Summary The importance of freeing an indirect inguinal hernial sac or a peritoneal protrusion at the internal ring is discussed and emphasized. The technic at the internal ring used at the Shouldice Clinic is described. The justification for this technic lies in the results obtained. An analysis of more than 32,000 inguinal herniorrhaphies performed in this hospital between 1945 and 1961 is. mesh is placed and secured in hernia defect. High Ligation/Marcy: Used in pediatric patients, high ligation (at the deep ring) and transection of an indirect hernia sac. Additionally, sutures are used to tighten the deep ring without repair of inguinal floor. Stoppa/Giant Prosthetic Reinforcement of the Visceral Sac: Open pre An indirect hernia occurs when a hernia sac enters the deep inguinal ring lateral to the inferior epigastric artery and passes indirectly to the superficial ring through the inguinal canal. HIGH LIGATION OF HERNIA SAC. Direct Inguinal Hernia hernia is the most common surgical abdominal inadults. the sac got important place hernia surgery at theexpense of 'defect'. It is long held that ligating the sac is an important adjunct to groin hernia operations.1 reports discussing recurrence considered excision and high ligation of the indirect inguinal hernia

The advances in anatomical knowledge of hernia lead to the introduction of two important rules for hernia surgery: high ligation of hernia sac and narrowing of the internal inguinal ring. Among techniques that received some fame among XIXth century surgeons we should mention the techniques of William Wood, Vinzenz Czerny and James Heaton Laparoscopic reduction of incarcerated right obturator hernia and high ligation of obturator hernia sac. Small bowel was viable. Case Discussion. Obturator hernias occur through the obturator canal, which contains the neurovascular bundle and is about 2-3 cm long. It is more common in elderly females (as in this case) likely due to increased. He performed high ligation of the hernia sac as well as closure of the internal ring to repair indirect hernias. This is a procedure that is still used widely today especially in pediatric patients. Edoardo Bassini. Edoardo Bassini was an Italian surgeon from the early 20th century. Everyone considers him the father of modern herniorrhaphy Bassini's repair emphasizes both high ligation of the hernia sac in the internal ring as well as suture reinforcement of the posterior inguinal canal. The operation also utilizes a deep and superficial closure of the inguinal canal. In the deep portion of the repair, interrupted sutures affixing the transversalis fascia medially to the.

No More Hernia Surger

An incisional hernia occurs at or in close proximity to a surgical incision through which intestine, organ or other tissue protrudes. Click image to enlarge. Incisional Hernia Causes. Incisional hernias result from a weakening of the abdominal muscle due to a surgical incision. An incisional hernia can occur for a number of specific reasons. Hernia sac tear/entry No — 208 82.5 Yes 44 17.5 Wound complication‡ No — 246 97.6 Yes 6 2.4 Surgeon type§ General surgeon (1) — 104 41.3 General surgeons (13) 110 43.6 Residents (4) 38 15.1 *As referred by the surgeon in the operative note. †Main distinguishing factors of each repair: High ligation: high suture liga Bassini, in 1884, devised a method of hernia repair that called for a three-layer reconstruction of the inguinal floor. After division of the posterior wall of the inguinal canal and herniotomy (high ligation and excision of the sac), Bassini performed a triple layer repair of the inguinal floor. He approximated the internal obliqu sciatic hernia (Figure 3, Figure 4, and Figure 5) that was repaired by high ligation of the hernia sac; a concurrent left Richter obturator hernia (Figure 6, Figure 7, and Fig-ure 8) was also revealed, which was repaired with mesh. The patient developed brief postoperative ileus, but the remainder of the recovery was otherwise uneventful, an

Inguinal hernia repair is one on the most frequently performed operative procedures in pediatric surgery. The technique of high ligation of the hernia sac has been described for over a century and has proven to be a highly effective and durable repair. Several laparoscopic repairs have been described but, at least in boys, all of them have a slightly higher recurrence rate If the content is solid (e.g. bowel, omentum, appendix, ovary) coming down a wide processus, it is a hernia. Surgically speaking, we repair hernias and hydroceles in the same way - i.e. high ligation of processus vaginalis. Hydrocoeles are much less urgent a referral, as they will generally resolve over time. They can also appear when the. Spigelian hernia (arrow) following reduction of hernia contents. Following the procedure, she felt significantly improved and 8 months after surgery is still pain free. Discussion. The Spigelian hernia was named after the Flemish anatomist Adriaan van den Spieghel, who was the first person to describe the semilunar or Spigelian line The danger with high ligation of an indirect hernia sac, without proper inspection of the sac, is injury to the bowel within a sliding hernia. Following inspection of the spermatic cord and reduction of any indirect sac and excision of any preperitoneal fat, attention is turned to the posterior inguinal canal Emergency high ligation in a suspected COVID-19 pediatric patient with incarcerated inguinal hernia: A case report Gunadi , Munawir Makkadafi, Aditya Rifqi Fauzi, Amsyar Praja, Kemala Athollah, Marcellu

The hernia contents were reduced into the abdomen through the inguinal canal and a high ligation plus additional repair of the internal inguinal ring were performed. Processus vaginalis develops at around the sixth month of fetal growth as an evagination of parietal peritoneum Placing a plug of mesh in the hernia defect and then overlaying a patch of mesh over inguinal floor (require few, if any, sutures in mesh) Define High Ligation procedure Ligation and transection of indirect hernia sac without repair of inguinal floor (used only in children

Do High Hernia - Do High Herni

Repair - All hernias should be repaired when identified to minimize complications. Repair in children differs from adults. As on most children the hernia is indirect, the sac in dissected and removed (high ligation of the sac). That is all that is required an the inguinal canal is closed High ligation of the patent processus vaginalis (PPV) as basis of the treatment of indirect inguinal hernia in pediatric patients is not applied to adults. Instead, the popular options are the laparoscopic transabdominal preperitoneal (TAPP) approach or totally extra peritoneal (TEP) approach Strangulated inguinal hernia is a life-threatening condition which requires urgent surgical intervention. Historically, the prominence of adhesive bands as a cause of intestinal obstruction was already known, and was also the main historical cause of small intestinal obstruction before the advent of anesthesia

High ligation in adolescents: Is it enough

Two-center Analysis of Long-term Outcomes after High

Pediatric Umbilical Hernia: Basics. Umbilical hernias occur due to a failure of the umbilical ring to completely close after birth . All newborns, by definition, have a small umbilical hernia that the umbilical vessels pass through. Typically, the umbilical ring closes during the first few days to weeks of life INTRODUCTION: Herniotomy is performed along with orchidopexy for the closure of associated patent processus vaginalis. The conventional technique for undesended testis repair is high ligation of the hernial sac after proper dissection upto the deep ring, Mohta et al. [1] Observed that there is no untoward effect on the early complications and recurrence rate, if hernia sac is not ligated.

Hernias of the Inguinal Region Operative Pediatric

Definition A hernia is the protrusion of an organ through its containing wall. 4. Composition of a hernia 1. The sac 2. The covering of the sac 3. The content of the sac. 5. Composition of a hernia 1. The sac : It is a diverticulum of peritoneum and is made up of three parts : The mouth, The neck and The body of the sac Hernia — A hernia is the protrusion of a portion of an organ or tissue through an abnormal opening in the wall that normally contains it. Incarceration — Incarceration describes a hernia that cannot be reduced by manipulation. An incarcerated hernia may or may not be strangulated Introduction. Inguinal hernia is a common cause of patient referral for surgery and in children, it is almost always an indirect type, which is treated by sac dissection, transection, and high ligation (classic treatment) 1.When the internal ring is very large, its tightening is recommended 2.Although cutting of the sac, which is the pathway of the viscera into the inguinal canal, is mandatory.

High ligation of the sac in indirect inguinal hernia

Inguinal hernia is a common disease in children. Treatment of this disease by laparoscopic high ligation of the hernia sac has been accepted by domestic and foreign scholars. Since laparoscopic inguinal hernia was introduced in 1990,it has now become the most commonly performed hernia repair in children High ligation of the PV is an effective method for successful orchiopexy and prevention of inguinal hernia in patients with NPT and UT. Free full text Rambam Maimonides Med J . 2016 Jul; 7(3): e0020 Laparoscopic surgery for indirect inguinal hernia in children has the advantages of low trauma and a rapid postoperative recovery. An inner ring diameter ≥ 1.0 cm, the use of absorbable ligature, and age > 3 years may increase the risk of recurrence after laparoscopic high ligation of the hernia sac. Keywords: Laparoscopic high ligation of. DISCUSSION: The Bassini repair is accomplished by high ligation of the hernia sac followed by suturing the conjoined tendon and the internal oblique muscle to the inguinal ligament. 7. Which of the following statements concerning the abdominal wall layers are correct? A. Scarpa's fascia affords little strength in wound closure. B Hernia 1. Omar Khayyam Ramos Macadato 2. Sir Astley Cooper Recommended a truss rather than surgery; only indication for surgery was strangulation Lucas-Championnière 1881 Performed high ligation of an indirect inguinal hernia sac at the internal ring Edoardo Bassini 1844-1924 dissection of the layers of the inguinal canal to the transversalis fascia & reconstruction of the floor of the.

1. Hernias inguinal hernia repair high ligation Glycolipids Only in children. ligation/transection of indirect sac w/o repair of inguinal floor Solid components, papillary projections, septations, incr vascular flow on doppler Proximal duct - resection + roux en y distal duct - whippl High Ligation; Marcy; Maloney; Kugel; Stoppa; Trabucco; Wantz; Coskun; Darning; Desarda; Ringplasty; If you think you may be suffering from a sports hernia, please consider making an appointment with Dr. Brown to see if you're right. Dr. Brown specializes in working with hernia patients, and is an expert at the process of diagnosis, treatment. Step 6: management of hernial sac The term high ligation of the sac is used frequently in discussing inguinal hernia repair; its historical significance has ingrained it in the descriptions of most of the older operations. For our purposes in this chapter, high ligation of the sac should be considered equivalent to reduction of the sac into the. Ligation of Patent Processus Vaginalis (PPV) is the name of the operation used to treat a HYDROCELE in a young child. A hydrocele in young people is usually caused by a connection that runs between the tummy and the scrotum (the patent processes vaginalis.) The aim of this operation is to divide this connection. I

Any hernia that you see bulging yourself should be repaired. All hernias in women should be repaired. Hernias in children ought to be repaired with high ligation of the sac. How are you going to fix my hernia? Inguinal hernia repairs have undergone quite an evolution over the past hundred years or so. Bassini perfected a technique that still. A Life-Threatening Problem Hidden Within a Hiatal Hernia adding that published reports range from cases of spontaneous healing to high-dose PPI with band ligation and clipping shown to be.

Sac ligation in inguinal hernia repair: A meta-analysis of

  1. al cavity
  2. Inguinal hernia repair is a common surgical procedure. Inguinal hernia surgery is also called herniorrhaphy or hernioplasty. There are 3 types of inguinal hernia repair: Open hernia repair: A surgical procedure in which an incision, or cut, is made in the groin. The surgeon then pushes the hernia back into the abdomen and strengthens the.
  3. High fiber diet. Increase in fluids. Sitz bath. Grade I-III (Hemorrhoids may be manually reduced) Sclerotherapy. Rubber band ligation. Electrocoagulation. Grade IV (Can not be manually reduced) or thrombosed. Surgical excision. Hernias Things to Know. The movement of an organ through the wall which normally contains it. Reducible hernia - the.
  4. al surgery
  5. This hernia has also been associated with a congenital, sex-linked, recessive disorder in dogs called ectodermal dysplasia. 79. which includes apposition of strong tissues without tension and high hernial sac ligation. Uncomplicated unilateral inguinal hernias are approached over the inguinal rings. In more complicated hernias (incarcerated.
  6. In direct inguinal hernia in old persons, those with hernia-en-glissade or a large and long-standing indirect inguinal hernia with a wide neck, a truss can frequently be advised. Even in an old person a femoral hernia will require operative treatment. High ligation and excision of an indirect inguinal hernial sac together with orchidectom
  7. Pain after inguinal hernia surgery is a common complaint in surgical wards. There are many reasons for post operative pain. This study compares post-operative pain among patients undergoing high sac ligation versus sac reduction in elective Lichtenstein inguinal hernia repair

Treatment of Inguinal Hernias: For Laparoscopic High Ligatio

  1. The meticulous dissection of inguinal canal and identification of the inguinal structures are of utmost importance in hernia surgery. Misidentification, incomplete ligation of the sac and a missed small indirect sac in saddle bag hernia are common causes of recurrence.4 The management, however, remains the same as for the repair of other inguinal hernias in adults and only involves adequate.
  2. Sidebar: Management of the Peritoneal Sac of an Indirect Hernia. The classic herniorrhaphists describe the need for a high dissection and high ligation of the peritoneal sac in the iliac fossa. The threshold of the internal ring must be freed of peritoneal sac. This can be accomplished with a full dissection and invagination of the sac, or in.
  3. Carr, Jennifer S. McLeod, Joseph T. Church, Lily Hsieh, Niki Matusko, James D. Geiger, Ronald B. Hirschl, Samir K. Gadepall
  4. nora_mae74079. I have been having issues since I had a Tibial ligation in1994. Any one touching my tummy was told dont it hurts. I was haveing a monthly bleed twice a month. That got stopped after 18 years in 2010 due to what they thought was a cyst on my left ovary.It was not a cyst as told by the OBGYN that would say I may of been bleeding.
  5. Hemorrhoids, however, are itchier than a hernia. Internal hemorrhoids also produce bright red blood after a bowel movement. Hemorrhoids cannot cause hernias, either, but a person is more likely to have hemorrhoids and hernias if it runs in their family. Genetics plays an overpowering role in the conditions we develop, either early on, or later.

Hiatal hernia - Symptoms and causes - Mayo Clini

Inguinal Hernia - TEP - HD - Large Sac Ligation - YouTub

estimate of the length of the learning curve. For pediatric hernia, no studies have compared surgical exploration for a contralateral hernia with watchful waiting, but comparing laparoscopy versus open high ligation, outcomes generally favored laparoscopy In this case, Dr. Alvear performs an open right inguinal herniorrhaphy on a 1-year-old male using his own technique involving high ligation of the hernia sac and internal ring repair. This was filmed during a surgical mission in Honduras with the World Surgical Foundation These results have been reflected in a recent study by Lee and Park15 who reported that addition of IPT repair to high ligation significantly reduced recurrence although small. Laparoscopic inguinal hernia repair has been used fairly commonly in adults A femoral hernia is a bulge in the upper thigh, just below the groin. This type of hernia is more common in women than men. A hiatal hernia occurs in the upper part of the stomach. Part of the upper stomach pushes into the chest cavity in this type of hernia. An incisional hernia can occur through a scar if you have had abdominal surgery in the.

Hernia sac excision-to be repaired later Medical Billing

Hernia sac - Libre Pathology. ABSTRACT. The hernia sac is a common surgical pathology specimen which can occasionally yield unexpected diagnoses. The. College of American Sac ligation in inguinal hernia repair: A meta-analysis of randomized There is a debate about how the indirect hernia sac should be treated in order to prevent hernia recurrence 4 TheInguinalOperationforFemoral Hernia. Edby modernsurgeonstheworld overasthene plus ultraofper- fection, Bassini(2)appears to deserve the credit, also,ofbeing thefirsttomakesystematic,continuedand rational attemptsat theradicalcure offemoralherniaby suturing crural ring, canal andsaphenous opening. Bassini(2)reports54 operationsupon 40womenand 11 men, three patients being operated upon o

Hernia repair and complex abdominal wall reconstruction

Post herniorrhaphy pain syndrome, or inguinodynia is pain or discomfort lasting greater than 3 months after surgery of inguinal hernia. Randomized trials of laparoscopic vs open inguinal hernia repair have demonstrated similar recurrence rates with the use of mesh and have identified that chronic groin pain (>10%) surpasses recurrence (<2%) and is an important measure of success Ligation of the Fifty consecutive children under the age of 12 years (range 5 hernial sac has been considered mandatory for a suc- months to 12 years) undergoing herniotomy for inguinal hernia and cessful repair. The present report was designed to study orchiopexy were selected for the study Background: A herniotomy through a groin incision is the gold standard treatment for pediatric inguinal hernia, the cornerstone of which is a high ligation of the hernia sac. In the last few decades, laparoscopic surgery has challenged this conventional surgery. The advantages of a laparoscopic approach include the avoidance of access trauma to the cord structures, decreased operative time. consent was obtained by Dr. _____ for a (right/left) inguinal hernia repair with mesh which we performed today. OPERATIVE NOTE: The patient was brought to the operating room where a surgical safety checklist was performed. Preoperatively, ___ grams of IV Ancef/Vancomycin was administered. General/regional/local anaesthetic was used

Video: Pediatric Hernias Treatment & Management: Medical Care

Treatment of Routine Adolescent Inguinal Hernia Vastly

  1. The ability to detect and repair the contralateral opening of internal rings simultaneously, along with safe high ligation of the hernia sac without injury of the vas deference or the spermatic vessels, make laparoscopic approach a reliable alternative to the conventional open techniques
  2. Indirect inguinal hernia treated with laparoscopic high ligation of hernial sac in child patients: with a report of 32 cases 腹腔镜 下 小儿 腹股沟 斜 疝疝 囊 高位 结扎 32 例 报告 www.ilib.c
  3. Raghavendra Rao, MD, Michael Smith, Troy Markel, MD, Brian Gray, MD, Matthew Landman, MD.IU. Introduction: The subcutaneous endoscopic assisted ligation (SEAL) is a technique of pediatric laparoscopic hernia repair which has recently been incorporated by pediatric surgeons.This technical details of SEAL remain controversial. We present the outcomes of our large experience with this technique.
  4. However, the length of stay was significantly different between the 4 methods (P = 0.003). In the post hoc analysis, there were significant differences between the high ligation (removal of the hernia sac only) and Lichtenstein groups on the length of stay (high ligation vs. Lichtenstein, 13.1 ± 5.6 vs. 19.6 ± 10.1; P = 0.002)
HerniaTreatment of Inguinal Hernias: For Laparoscopic HighUndescended testisPediatric Laparoscopic Inguinal Hernia Repair: A Review of

Subcutaneous endoscopically assisted ligation (SEAL) is a technique for high ligation of the patent processus at the internal ring without a groin incision or dissection of the vas and vessels. Under endoscopic visualization through a single umbilical port, a suture is guided extraperitoneally around the internal ring, avoiding the vas and vessels HERNIA, VASCULAR & LYMPHATIC DISEASES By Dr. Christopher Awil HERNIA The term hernia is derived from the anatomy & pathophysio of inguinal hernias coupled with the development of aseptic technique perform sac dissection, high ligation, (PPV), hence the high incidence of indirect inguinal hernias in preterm babies. The presence of. Left-sided incarcerated Amyand's hernia with cecum and terminal ileum: a case report Kebebe Bekele,1 Desalegn Markos2 1Department of Surgery, School of Medicine, Madda Walabu University, Bale Robe, Ethiopia; 2Unit of Neonatology Nursing, St Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia Background: Amyand's hernia, which is the presence of a normal or pathological appendix. Aim To evaluate the feasibility and safety of laparoscopic ligation of internal ring in congenital inguinal hernia in children.. Patients and methods Laparoscopic percutaneous ligation of internal inguinal ring has been performed on 97 children with 133 hernias. The age ranged between 6 months and 11.5 years. The procedure was carried out under general anesthesia, through skin puncture. The processus vaginalis was cleared back to peritoneal reflection at the deep inguinal ring and a high ligation was performed there using both the transfixing and a mass ligature of 3-0 Vicryl. After the excess hydrocele and processus vaginalis tissue was excised, the spermatic cord structures were replaced and the external oblique and Scarpa's. Inguinal Hernia (IH) is common in pediatric age group and its incidence range from 0.8% to 4.4%.1,2 IH repair is one of the most common elective surgeries in pediatric population.3-6 Open repair of inguinal hernia with high ligation was adopted for inguinal hernia treatment and was practiced for decades before the introduction of minimal.