hernia repair 4
TRANSCRIPT
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8/9/2019 Hernia Repair 4
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N H}qi @ac Klbb Hiilsshihc 955?68=*3-
?1
KLG[AYTHSMTA @HGHOA@AGS LD @A[J [MSA MGDAKSMLG MG
TAGSYHB JAYGMH YAUHMY
[hnnhc Hj`hc" Shymx [haac @qdsm" Hy{jhc ^hdhy" M{`hmb HfihyCauhys`ags [qyoay}" H}qi @acmkhb Klbbaoa" Hiilsshihc" Uhfm{shg
Ihkfoylqgc> @a{j Jaygmlubh{s} m{ sja uyadayyac {qyomkhb uylkacqya dly hicl`mghb whbb jaygmh{hgc mgdaksmlg ya`hmg{ lga ld sja `l{s kl``lg kl`ubmkhsmlg{ ld sjm{ sakjgmxqa' Mg {l`a uhsmags{
sja `a{j `h} gaac ya`lthb sl ltaykl`a mgdaksmlg" wjaya h{ lsjay{ `h} ia {hbthoac i}
klg{aythsmta syahs`ags' Sjm{ {sqc} wh{ klgcqksac sl h{{a{{ sja lqskl a ld klg{aythsmta`hghoa`ags dly `a{j {msa mgdaksmlg mg hicl`mghb whbb jaygmh yauhmy{' @asjlc{> Sjm{ {sqc} wh{
khyymac lqs mg H}qi Sahkjmgo Jl{umshb Hiilsshihc Uhfm{shg dyl` Nhg 9554 sl Cak 955?' Sjmysaagklg{akqsmta kh{a{ waya mgkbqcac" wjl catabluac `a{j {msa mgdaksmlg hdsay hicl`mghb whbb jaygmh
yauhmy' Uq{ ly uqyqbags dbqmc wh{ {ags dly kqbsqya hgc {ag{msmtms}' Hbb uhsmags{ waya syahsac i}mgsyhtaglq{ hgsmimlsmk{ hgc blkhb wlqgc khya' Syahs`ags wh{ shfag h{ {qkka{{dqb wjag sjaya wh{
kl`ubasa ya{lbqsmlg ld mgdaksmlg hgc jahbmgo ld sja wlqgc' Ya{qbs{> Sjaya waya ? mgoqmghb
*1;':3!-" 3 uhyhq`imbmkhb *;5'?4!- hgc 9 mgkm{mlghb jaygmh{ *81';:!-' Amojs uhsmags{ waya `hba{
*48'1;!- hgc 1 da`hba{ *;:'34!-' @acmhg hoa ld sja uhsmags{ wh{ 35 }ahy{ *yhgoa 9: sl 19 }ahy{-'[shuj}blklkkq{ hqyaq{ wh{ sja `l{s kl``lgb} dlqgc lyohgm{` khq{mgo mgdaksmlg mg : uhsmags{"
*?4'=!-' @ahg jl{umshb {sh} wh{ 99 ch}{ *yhgoa 8:94 ch}{-' Hbb kh{a{ waya addaksmtab} syahsac
klg{aythsmtab} wmsjlqs ya`ltmgo sja `a{j' Ulb}uylu}baga `a{j wh{ q{ac mg hbb ld sja{a kh{a{'Klgkbq{mlg> Klg{aythsmta `hghoa`ags m{ bmfab} sl ia {qkka{{dqb mg `a{j {msa mgdaksmlg mg
hicl`mghb whbb jaygmh yauhmy{'Fa} wlyc{> Hicl`mghb jaygmh" @a{j" Mgdaksmlg
MGSYLCQKSMLG
Hicl`mghb whbb jaygmh m{ h `hnly jahbsj uyliba` hgc
lgb} mg Qgmsac [shsa{ huuylzm`hsab} =5"555 tagsyhbjaygmh{ hya yauhmyac atay} }ahy'8
@a{j yauhmy m{ dhtlqyac {qyomkhb uylkacqya
iakhq{a sjaya jh{ iaag h {mogmdmkhgs cakyah{a mgyakqyyagka yhsa h{ kl`uhyac sl {qsqya yauhmy'
9";
Ulb}uylu}bmga *UU- hgc Ulb}sasyhdbqlylasj}baga
*USDA- hya sja `l{s kl``lgb} q{ac uyl{sjasmk
`hsaymhb{' Sja UU `a{ja{ hya h `lgldmbh`ags
ulb}uylu}baga `a{j" glghi{lyihiba" mgays" {saymbahgc ulylq{ wmsj h sjmkfga{{ huuylzm`hsab} ld
5'33 ``' Sja USDA `a{j m{ 8 `` sjmkf `a{j `hca
dyl`{sylgo" {lds mgays hgc klgdly`hiba {syqksqya
sjhs
ag{qya{ ahyb} dmzhsmlg sl jl{s sm{{qa wmsj `mgm`hb
dlyamogilc} yahksmlg' Ilsj hya imlblomkhbb} mgays hgc
hbblw oylwsj ld sja hcnhkags sm{{qa{ mg `mkyl {uhka{
ld `a{j" ya{qbsmgo mg cqyhiba hgc {sylgo jaygmh
yauhmy'
3
Mgdaksmlg m{ sja `l{s kl``lgb} yaulysachctay{a atags mg lsjaywm{a kbahg kh{a{ ld uyl{sjasmk
jaygmh yauhmy'1
Q{a ld uyluj}bhksmk hgsmimlsmk{ khgcakyah{a iqs khggls uyatags sja mgdaksmlg' Mgdaksmlg
yhsa ld qu sl 8'1! jh{ iaag yaulysac mg bmsayhsqya'4
[mgka" bhyoa gq`iay ld uyl{sjasmk jaygmh yauhmy{ hya
uaydly`ac atay} }ahy" {mogmdmkhgs gq`iay ld `a{jmgdaksmlg{ `h} ia azuaksac' Md ya`lthb ld `a{j m{ sja
lgb} kjlmka dly mgdaksmlg" ms wmbb ia dahydqb ilsj dly
{qyoalg hgc sja uhsmags sl lus dly uyl{sjasmk yauhmy' Ms
{jlqbc ia {sya{{ac sjhs ya`lthb ld `a{j m{ ldsag hsakjgmkhbb} cmddmkqbs uylkacqya' Cqa sl blkhb sm{{qa
mgklyulyhsmlg mg sl sja `a{j" ya`lthb m{ chgoaylq{
hgc `h} bahc sl hkqsa ibaacmgo ly agsaylkqshgalq{
dm{sqbh hdsay hcnhkags th{kqbhy ly oqs mgnqy}' Dhmbqya slkbl{a uym`hy} cadaks `h} bahc sl h bhyoay mgkm{mlghb
jaygmh'9 Sjm{ {sqc} wh{ khyymac lqs sl li{ayta sja
lqskl`a ld klg{aythsmta `hghoa`ags dly `a{j {msa
mgdaksmlg mg hicl`mghb whbb jaygmh yauhmy'
@HSAYMHB HGC @ASJLC[
Sjm{ {sqc} wh{ klgcqksac mg cauhys`ags ld {qyoay} ldH}qi Sahkjmgo Jl{umshb Hiilsshihc dyl` Nhg 9554
sl Caka`iay 955?' Hbb sja uhsmags{ wmsj `a{j {msa
mgdaksmlg hdsay oylmg" uhyhq`imbmkhb ly mgkm{mlghb
jaygmh yauhmy mg sjm{ qgms ly ul{sluayhsac uhsmags{yadayyac dyl` uaymujayhb jl{umshb{ waya mgkbqcac mg
sjm{ {sqc}' _lqgc mgdaksmlg wh{ cmhogl{ac i}
kbmgmkhb atmcagka ld uhmg" yacga{{" mgcqyhsmlg" datayhgc uqyqbags cm{kjhyoa' Uhsmags{ jhtmgo uhmgba{{
dbqksqhgs {wabbmgo waya azkbqcac hdsay gaohsmta
kqbsqya {ag{msmtms} hgc {ayl`h dbqmc yaulys{'
Blkhb `hghoa`ags mgkbqcac ya`lthb ld {fmg{qsqya{" luagmgo ld wlqgc hgc cyhmghoa ld uq{"
myymohsmlg wmsj {hbmga,Ultmclga Mlcmga hgc oagsba
caiymca`ags ld sja wlqgc' Sja{a `ah{qya{ waya
yauahsac smbb sja wlqgc hgc `a{j waya kbahy ld uq{hgc gakylsmk sm{{qa' Uq{ ly uqyqbags cm{kjhyoa wh{
shfag dly kqbsqya hgc {ag{msmtms}' A`umymkhb hgsmimlsmk
syahs`ags" h{ M,T mgnaksmlg{ *Dbqkblzhkmbbmg 915 `o&H`lzmkmbbmg 915 `o 4 jlqyb} hgc Oagsh`}kmg 1 `o,
fo,ch}- wh{ {shysac mg hbb kh{a{ hgc klgsmgqac
hkklycmgo sl {ag{msmtms} yaulys" smbb sja wlqgc wh{
kbahg' Kbl{qya ld sja wlqgc wh{ gls hssa`usac mg hg}kh{a hgc cadaks wh{ bads sl jahb ms {abd'
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8/9/2019 Hernia Repair 4
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N H}qi @ac Klbb Hiilsshihc 955?68=*3-
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Dmoqya8>Kl`ubasa wlqgc cajm{kagka
Dmoqya9> @a{j kltayac wmsj oyhgqbhsmlg sm{{qa mg{h`a kh{a
Dmoqya;> Kl`ubasa jahbmgo mg {h`a kh{a
YA[QBS[
Shiba 8 {jlw{ cm{symiqsmlg ld cmddayags kh{a{'Sjaya waya ? mgoqmghb *1;':3!-" 3 uhyh
q`imbmkhb *;5'?4!- hgc 9 mgkm{mlghb jaygmh{
*81';:!-' Amojs uhsmags{ waya `hba{ *48'1;!- hgc 1
da`hba{ *;:'34!-' Hbb sja uhsmags{ wmsj mgoqmghbjaygmh{ waya `hba' Htayhoa hoa ld sja uhsmags{ wh{
35 }ahy{ *yhgoa 9: sl 15 }ahy{-' [shuj}blklkkq{
hqyaq{ wh{ dlqgc mg : uhsmags{ *48'1;!- hgc A' klbm
mg ; uhsmags{ *9;'5?!-' Ulb}uylu}baga `a{j hgc
{qsqya{ waya q{ac mg hbb ld sja{a uhsmags{' Swluhsmags{ wmsj mgkm{mlghb jaygmh waya lia{a _msj I@M
ld ;;';3 hgc ;;'?:' *_amojs mg Fo cmtmcac i} jamojsmg {x' `asay-' Gl lsjay kl`lyimcms} hddaksmgo sja
lqskl`a wh{ casaksac' Swl uhsmags{ wmsj kabbqbmsa{waya cm{kjhyoac hdsay 8589 ch}{ wmsj dqbb yakltay}"
wmsj lqs luagmgo sja wlqgc' Amojs uhsmags{ gaacac
uhysmhb luagmgo ld wlqgc hgc mgdaksmlg mgtlbtmgo sja
`a{j wh{ klgdmy`ac' Sja{a uhsmags{ gaacac chmb}cya{{mgo{ hgc 1? caiymca`ags{' Sjyaa uhsmags{ jhc
{ataya {au{m{ hgc kl`ubasa cajm{kagka ld sja wlqgc
*Dmoqya8-' Sja{a sjyaa uhsmags{ jhc 8589caiymca`ags{ cqymgo syahs`ags' @ahg jl{umshb {sh} ld
hbb sja{a uhsmags{ wh{ 99 ch}{ *yhgoa 8:94 ch}{-'
Hbb sja uhsmags{ jhc dlbblw qu dly ; `lgsj{' Sjaya
wh{ gl yakqyyagka ld mgdaksmlg ly jaygmh cqymgo sjm{uaymlc' Yakltay} wh{ gls cmddayags mg lia{a uhsmags{'
Shiba8> [jlw{ cm{symiqsmlg ld cmddayags kh{a{
S}ua{ ld jaygmh
Gq`iay ld
kh{a{ !
Mgoqmghb Jaygmh
Uhyh q`imbmkhb jaygmh
Mgkm{mlghb Jaygmh
?
3
9
1;':3
;5'?4
81';:
CM[KQ[[MLG
Q{a ld uyl{sjasmk iml`hsaymhb{ dly sja yauhmy ld
hicl`mghb whbb jaygmh{ jh{ cakyah{ac yakqyyagka
yhsa{ wjag kl`uhyac wmsj {m`uba {qsqya kbl{qya?'
Mgdaksmlg dlbblwmgo hicl`mghb whbb jaygmh yauhmy `h}
ya{qbs mg {mogmdmkhgs `lyimcms}' Hbsjlqoj syhcmsmlghb{qyomkhb sahkjmgo hctlkhsa{ ya`lthb ld uyl{sjasmk
`hsaymhb{ wjagatay mgdaksmlg lkkqy{" gq`aylq{ kh{a{ld `a{j {hbthoa jhta iaag yaulysac mg sja bmsayhsqya'
Mg h uay{lghb {ayma{ ld `lya sjhg ;45 tagsyhb jaygmh`a{j yauhmy{" [sluuh jh{ yaulysac hg mgdaksmlg yhsa ld
89! hgc glga ld uyl{sja{m{ yaxqmyac ya`lthb:' Mg h
{m`mbhy {sqc} i} Bqmnagcmnf as hb kl`uhymgo {qsqya
yauhmy wmsj `a{j yauhmy ld mgkm{mlghb jaygmh{" sjyaa
lqs ld :3 uhsmags{ catabluac h wlqgc mgdaksmlgdlbblwmgo ulb}uylu}baga `a{j yauhmy' Hbb waya
{qkka{{dqbb} syahsac i} mgsyh taglq{ hgsmimlsmk{ hgc
blkhb wlqgc khya wmsjlqs ya`ltmgo sja `a{j=' Sjm{
{sqc} hb{l {jlw{ sjhs klg{aythsmta `hghoa`agsmgkbqcmgo {qmshiba mgsyhtaglq{ hgsmimlsmk{ hgc blkhb
`hghoa`ags m{ {qkka{{dqb dly `a{j {msa mgdaksmlg'Mg swl lqs ld 8; kh{a{ sja mgtlbta`ags ld
`a{j klqbc gls ia klgdmy`ac kbmgmkhbb}'
Qbsyh{lgloyhuj} khg ia q{ac sl casaks dbqmc
klbbaksmlg{6 yakqyyagka ld jaygmh" {quaydmkmhb hgc caau
mgdaksmlg{ mg `a{j yauhmy{'85
Gls lgb} mg kbahg kh{a{"sja ulb}uylu}baga `a{j jh{ hb{l iaag {qkka{{dqbb}
q{ac mg kbahg klgsh`mghsac hgc klgsh`mghsac dmabc{88'
Ms m{ hb{l q{ac mg abaksmta klblgmk luayhsmlg{ hgc dly
uhyh{sl`hb jaygmh{89
' Uyl{sjasmk yauhmy{ wmsjulb}uylu}baga jhta iaag hssa`usac mg {syhgoqbhsac
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8/9/2019 Hernia Repair 4
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N H}qi @ac Klbb Hiilsshihc 955?68=*3-
??
oylmg jaygmh{ wmsjlqs {mogmdmkhgs mgkyah{a mg
`lyimcms}8;
'Lg sja lsjay jhgc Htshg B as hb jhta
yaulysac dhmbqya ld klg{aythsmta `ah{qya{ dly {l`akh{a{ ld `a{j mgdaksmlg'83
Sja{a uhsmags{ qbsm`hsab}
yaxqmyac ya`lthb ld `a{j' [satag Y as hb hb{l`agsmlgac ya`lthb ld mgdaksac `a{j hdsay dhmbac
klg{aythsmta syahs`ags'81
KLGKBQ[MLG
Sjm{ {sqc}" mgkbqcmgo lgb} 8; kh{a{ klgkbqca{ sjhs
klg{aythsmta `hghoa`ags m{ bmfab} sl ia {qkka{{dqb
dly `a{j {msa mgdaksmlg' Sja{a uhsmags{ ya`hmg mgjl{umshb dly h blgoay cqyhsmlg hgc yaxqmya uylblgoac
hgsmimlsmk{ hgc caiymca`ags{' Qbsyh{lqgc khg ia
jabudqb sl cadmga sja {quaydmkmhb hgc caauay azsags ld
`a{j {msa mgdaksmlg'H bhyoay `qbsmkagsya {sqc} m{ yaxqmyac sl
lqsbmga h qgmtay{hb `hghoa`ags ld `a{j {msa
mgdaksmlg mg hicl`mghb whbb jaygmh yauhmy{'
YADAYAGKA[8' Ollcga} UU" Imyf`a}ay K@" Imyf`a}ay NC' [jlyssay`
Lqskl`a{ ld Bhuhyl{klumk hgc Luag Tagsyhb Jaygmh Yauhmy"
h @ashhghb}{m{> Hykj [qyo 955968;?>88481'
9' Klii _{" Faykjay F_" Jagmdlyc IS' Sja hyoq`ags dly bmojswamojs ulb}uylu}baga `a{j mg jaygmh yauhmy' [qyo Mgglt'
9551689*8->4;='
;' [hgnh} U" Yamc SC" Chtma{ AB" Hyq`qoh` UN" _llcwhyc H'Yasyl{uaksmta kl`uhym{lg ld `a{j hgc {qsqyac yauhmy dly
hcqbs q`imbmkhb jaygmh{' Jaygmh' 95516=*;->93:18'
3' Faykjay F_" [mgo YD" @hssjaw{ IC" Jagmdlyc IS'[qkka{{dqb [hbthoa ld Mgdaksac USDA @a{j hdsay TagsyhbJaygmh Yauhmy' L{sl`} _lqgc @hghoa' 955963:*85->351'
1' Ylimg{lg SG" Kbhyfa NJ" [kjlag N" _hb{a @C' @hnly `a{jyabhsac kl`ubmkhsmlg{ dlbblwmgo jaygmh yauhmy> atags{ yaulysac
sl sja Dllc hgc Cyqo Hc`mgm{syhsmlg' [qyo Agcl{k
955168=*89->811445'
4'
Hqdaghkfay SN" Flaba`h} @N" Olq`h CN" [m`lg{ @U'[}{sa`hsmk yatmaw hgc `ashhghb}{m{ ld sja addaksmtaga{{ ld
hgsmimlsmk uyluj}bhzm{ mg uyatagsmlg ld wlqgc mgdaksmlg hdsay
`a{j yauhmy ld hicl`mghb whbb jaygmh' Iy N [qyo
95546=;*8->185'
?' [hqaybhgc [" [kj`acs KO" Bamg [" Bamib IN" Imssgay Y'Uym`hy} mgkm{mlghb jaygmh yauhmy wmsj ly wmsjlqs
ulb}uylu}baga `a{j> h yaulys lg ;:3 uhsmags{ wmsj 1}ahy
dlbblwqu' Bhgoagiakf{ Hykj [qyo' 95516;=5*1->35:89'
:' [sluuh YA' Sja syahs`ags ld kl`ubmkhsac oylmg hgcmgkm{mlghb jaygmh{' _lybc N [qyo' 8=:=68;*1->13113'
=' Bqmnagcmnf Y_" Jlu _K" thg cag Slb @U" ca Bhgoa CK"Iyhhf{`h @@" MN~ay`hg{ NG" as hb' H kl`uhym{lg ld {qsqya
yauhmy wmsj `a{j yauhmy dly mgkm{mlghb jaygmh' G Agob N @ac'
95556;3;*4->;=9:'
85' Uhyyh NH" Yatqabsh [" Ohbbaol S" Iqagl N" Iayyml NM" Dhymgh{@K' Uyl{sjasmk `a{j q{ac dly mgoqmghb hgc tagsyhb jaygmh
yauhmy> gly`hb huuahyhgka hgc kl`ubmkhsmlg{ mg qbsyh{lqgchgc KS' Iy N Yhcmlb 95536??>9481'
88' Fabb} @A" Iajy`hg [_' Sja {hdas} hgc addmkhk} lduyl{sjasmk jaygmh yauhmy mg kbahgklgsh`mghsac hgc
klgsh`mghsac wlqgc{' H` [qyo' 955964:*4->193='
89' Imylbmgm K" Qsm}h`h A@" Ylcymxqa{ HN Ny" Imylbmgm C'Abaksmta klblgmk luayhsmlg hgc uyl{sjasmk yauhmy ld mgkm{mlghb
jaygmh> cla{ klgsh`mghsmlg klgsyhmgcmkhsa hicl`mghb whbb
uyl{sja{m{ q{a< N H` Klbb [qyo 955568=8*3->;44?9'
8;' Ia{{h [[" Fhsym F@" Hicab[hbh` _G" HicabIhfm GH'Ahyb} ya{qbs{ dyl` sja q{a ld sja Bmkjsag{samg yauhmy mg sja
`hghoa`ags ld {syhgoqbhsac oylmg jaygmh' Jaygmh>955?688*;->9;=39'
83' Htshg B" Htkm K" Iqbqs S" Dlqyshgmay O' @a{j mgdaksmlg{hdsay bhuhyl{klumk mgoqmghb jaygmh yauhmy> [qyo Bhuhyl{k
Agcl{k 8==?6?*;->8=91'
81' [~k~ayih [Y" Cq`hgmhg OH" Cadmgmsmta [qyomkhb Syahs`agsld Mgdaksac ly Azul{ac Tagsyhb Jaygmh @a{j' Hgg [qyo'
955;69;?*;->3;?38'
Hccya{{ dly Klyya{ulgcagka>Cy' [hnnhc Hj`ac" H{{m{shgs Uylda{{ly" Cauhys`ags ld [qyoay}" H}qi @acmkhb Klbbaoa" Hiilsshihc99535" Uhfm{shg'
A`hmb> cy{hnnhcyhnhEjls`hmb'kl`