RU2213528C1 - Method for transplantation inguinal hernioplasty - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: caprone netting of antimirobial action is designed according to the shape of inguinal space by the following technique: along the edge facing to the bottom of spermatic funiculus one should form three fragments by two parallel incisions at 1.5-2 cm length and 1 cm distance against transplant's longitudinal line. Transplant should be put onto posterior wall of inguinal canal so, that developed lateral fragments could cover the bottom of spermatic funiculus from three sides and median fragment to be turned down onto internal surface of spermatic funiculus at developing duplicature of internal edge of deep inguinal ring. Then comes fixation of transplant by tendinous elements of cross-sectional fascia and membranes of spermatic funiculus. The present method enables to increase reliability in plasty of posterior wall of inguinal canal. EFFECT: higher efficiency of operation. 2 dwg, 2 ex

Description

 The invention relates to medicine, namely to surgery for inguinal hernias, and can be used in the treatment of complex forms of inguinal hernias.

 Known methods for plastic surgery of complex forms of inguinal hernias, which include straight, large oblique with a straightened course, inguinal-scrotal, sliding, recurrent and repeatedly relapsing hernias, aimed at strengthening its posterior wall, using additional reinforcing materials (Yanov V.N., M., 1971, Kuzin A.A., Ufa, 1996, Alyautdinov PP, Gogia B.Sh., Adamyan A.A., M., 2001).

 The prototype of the present invention is a method of hernioplasty according to Liechtenstein (Lichtenstein IL, Shulman AG, Amid PK, Willias PA AORN. J. - 1990. - Vol.52, N3. - P.559-565), which consists in strengthening the inguinal gap with a synthetic mesh material. In this case, the graft is fixed to the connective tissue formations of the posterior wall of the inguinal canal without tensioning local tissues.

 The disadvantages of this method are the lack of formation of the inner edge of the deep inguinal ring and the place of transition of the transverse fascia to the membranes of the spermatic cord, the restoration of the structure of which is of great importance in fundamental works on herniology (Kukudzhanov NI, 1969, Ioffe I.L., 1968); and the lack of ability of the sutured synthetic transplant to withstand possible wound infections, which in some cases leads to rejection of the prosthesis (J. Bauer et al., 1987, J.S. Azagra et al., 1988).

 The technical result of the invention is to increase the reliability of the plasticity of the posterior wall of the inguinal canal, reduce purulent-inflammatory complications, and, as a result, reduce the recurrence of hernias.

 The technical result achieved is achieved by the fact that a kapron mesh with an antimicrobial effect is used as a graft, which is modeled by the shape of the inguinal gap so that along the edge facing the base of the spermatic cord, two parallel sections of 1.5-2 cm in length are formed at a distance of 1 cm from the longitudinal line of the graft, three flaps, lay the graft on the back wall of the inguinal canal so that the formed lateral flaps covered the base of the spermatic cord from three sides, and a single flap was folded onto the inner surface of the spermatic cord with the formation of a duplicate of the inner edge of the deep inguinal ring, and the graft was fixed by the tendon elements of the transverse fascia and the sheath of the spermatic cord.

 Figure 1 shows an implant with antimicrobial action and a formed flap to form a duplicate of the inner edge of the deep inguinal ring. Figure 2 shows a diagram of the strengthening of the posterior wall of the inguinal canal of the proposed method.

 The method of transplantation inguinal hernioplasty is as follows. After opening the front wall of the inguinal canal, the preparation of all its elements is performed. The hernial sac is isolated and treated in the usual way. A nylon mesh graft 1 having an antimicrobial effect (for example: according to the patent of the Russian Federation 2126694) is modeled in size and shape corresponding to the inguinal gap. The edge of the resulting graft, which will be fixed in the region of the deep inguinal ring, is formed as follows. Two parallel incisions are made 1.5-2 cm long at a distance of 1 cm from the longitudinal line of the graft each. The graft 1 is placed on the back wall of the inguinal canal, while the resulting median flap 2 is folded onto the inner surface of the spermatic cord, and due to the duplicate of the graft, the inner edge of the deep inguinal ring is formed, and the marginal flaps 3 are inserted above and below the exit site of the spermatic cord, covering it on three sides. Next, the nylon mesh is fixed with frequent interrupted sutures to the transverse fascia under the muscles in the deep inguinal ring, to the connected muscle aponeurosis, to the Cooper ligament, iliac-pubic cord, and the bent flap to the membranes of the spermatic cord 4 (Figs. 1, 2). Further plastic completes with one of the accepted methods.

 Example 1. Patient K., 45 years old. Diagnosis: recurrent right-sided oblique inguinal hernia. Previously operated on for oblique inguinal hernia by the method of Spasokukotsky with a suture of Kimbarovsky. A hernia recurrence occurred a year after surgery.

 Under local anesthesia with a solution of novocaine 0.25% -500 ml, the old postoperative scar is excised. The inguinal canal was opened in layers. From the scars and adhesions, the spermatic cord was isolated, opened, a hernial sac measuring 7.0 x 6.0 x 8.0 cm was selected from its elements. The latter was processed according to the usual method. The size of the deep inguinal ring is 2.5x1.0 cm. A double half-mesh seam is superimposed on the deep inguinal ring. The back wall of the inguinal canal is strengthened by installing a nylon mesh explant with a prolonged antibacterial effect. The latter, measuring 2x5 cm, is modeled on the size and shape of the inguinal gap. Two flaps were formed by two parallel sections 2 cm long at a distance of 1 cm from the longitudinal line of the explant. Lateral flaps are inserted above and below the exit site of the spermatic cord, and the median flap is bent to the inner surface of the spermatic cord with the formation of a duplicate inner edge of the deep inguinal ring. The explant is fixed with nodal nylon sutures (3) to the transverse fascia, pupartic and cooper ligaments, and the iliac-pubic cord. On top of the explant, the muscles are reduced according to the Kukujanov principle. Plastic surgery of the anterior wall is made in the form of duplicate aponeurosis. Hemostasis. Layered seams on the wound. Aseptic dressing. There were no complications during the operation.

 The patient was examined after 1 year. No complaints, no recurrence of the disease.

 Example 2. Patient A., 68 years old. Diagnosis: a right-sided oblique inguinal hernia of large sizes with a straightened course.

 Under local anesthesia with a solution of novocaine 0.25% -500 ml, the inguinal canal was opened in layers. The hernial sac is part of the spermatic cord. After opening the latter, it is isolated, the dimensions are 7.0x8.0x8.0 cm, processed according to the usual method. A defect was formed in the area of the deep inguinal ring with dimensions of 3.0 x 3.0 cm. In addition, an atrophied transverse fascia is determined, as a result of which there is a prolapse of the entire posterior wall of the inguinal canal. On the deep inguinal ring, a double half-cetic suture is imposed, on the transverse fascia - U-shaped corrugating seams. The explant was modeled with dimensions 3.0x2.0 cm according to the method described above, laid on the back wall of the inguinal canal with strengthening of the deep inguinal ring region with lateral flaps, fixed with nodal nylon sutures to the transverse fascia, iliac pubic cord, and cooper ligament. Further hernioplasty was performed according to the accepted reconstructive technique. Hemostasis. Layered seams on the wound. Aseptic dressing. There were no complications during the operation.

 The patient was examined after 1 year. No complaints, no recurrence of the disease.

 This method is used in a clinic for inguinal hernioplasty in 12 patients with complex forms of inguinal hernias. No postoperative wound complications were noted. Long-term results were traced from 6 months to 1 year, no relapses were found.

Claims (1)

 A method of transplantation inguinal hernioplasty, comprising fixing a synthetic mesh graft onto the posterior wall of the inguinal canal, characterized in that a kapron mesh with an antimicrobial effect is used as a graft, which is modeled in the shape of the inguinal gap so that along the edge facing the base of the spermatic cord they are formed with two parallel sections 1.5-2 cm long at a distance of 1 cm from the longitudinal line of the graft, three flaps, lay the graft on the back wall of the inguinal channel so that the formed lateral flaps covered the base of the spermatic cord on three sides, and the median flap was folded onto the inner surface of the spermatic cord with the formation of a duplicate of the inner edge of the deep inguinal ring, and the graft was fixed by the tendon elements of the transverse fascia and the membrane of the spermatic cord.

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