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The U and the Sushi Roll:  A Conceptual Aid for Lichtenstein Hernia Repair

Jessica A. Yu, MD; Clay Cothren Burlew, MD
Arch Surg. 2012;147(10):970-972. doi:10.1001/archsurg.2012.1772.
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For surgical trainees, perfecting a systematic approach to open inguinal herniorrhaphy can be complicated by the difficulty of conceptualizing hernias in relationship to the relatively complex anatomy of the inguinal canal. Open inguinal hernia repair is a common general surgery operation and a precise understanding of the operation is essential for residents. We present a systematic approach to this operation that uses the U and sushi roll technique as a conceptual aid to understand inguinal anatomy and a method of hernia repair.

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Graphic Jump Location

Figure 1. The U. A, The inferior arm is the shelving edge of the inguinal ligament (solid arrow); the superior arm is the conjoint tendon (dashed arrow); and the pubic tubercle (black dot) is the apex. B, Completed dissection of the U. The Penrose drain encircles the hernia and cord structures (asterisk).

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Graphic Jump Location

Figure 2. The sushi roll. The hernia sac (fish) lies anteromedial to the cord structures (avocado). There is a clear plane between the 2 once the cremasteric fibers (seaweed) have been dissected.

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Graphic Jump Location

Figure 3. The completed hernia dissection with application of the mesh. The U (solid line) outlines the points of mesh fixation, secured with interrupted sutures starting at the pubic tubercle (asterisks). An inferior cut in the mesh (dotted line) creates a new internal ring (circle) for the cord structures, which have been retracted superiorly.




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