RU2228719C1 - Method for surgical treatment of inguinal hernias - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: the present innovation deals with treating hernias of anterior abdominal wall. The method deals with separation of parietal peritoneum, isolation of internal opening of inguinal canal and hernia sac together with its content up to the cervix, external opening of inguinal canal, resection of excessive parts of hernia sac and putting its content into free abdominal cavity, creation of visualized space adequate to the size of latticed implant, drainage and suturing of the wound. The new fact is that in area of posterior wall of inguinal canal in front of cross-sectional fascia one should apply a latticed titanium nickelide implant onto area corresponding to the projection of both inguinal and femoral canals. Along internal and external edges of this implant one may observe porous fixing plates made of titanium nickelide at 0.3-0.5 thickness, the distance between these plates corresponds 5-10 mm that prevents the relapse. EFFECT: higher efficiency of surgical treatment. 1 ex

Description

The invention relates to medicine, namely to surgery, and can be used in the treatment of hernias of the anterior abdominal wall.

The closest technical solution is a method of surgical treatment of an inguinal hernia, in which the parietal peritoneum is removed with a retroperitoneoscope, the inner opening of the inguinal canal, the spermatic cord with a hernial sac is isolated, the last is separated from the spermatic cord or the round ligament of the uterus to the cervix, then the external opening of the inguinal canal is isolated , pubic joint, exfoliate the peritoneum from the anterior abdominal wall for 4-5 cm from the pubic joint to achieve a sufficient amount of visual space For the size adequate to the mesh implant, the lower edge of the mesh is clamped in the clamping device and with its help the implant is shaped like a tube, leaving its upper edge free for a length of 1.5-2 cm, the thus formed implant is placed in the prepared pocket, then the upper the edge is fixed with “fixers” through punctures of the anterior abdominal wall, the implant is expanded taking into account the closure of the areas of inguinal and femoral hernia formation, the wound is drained according to Redon, the fixators are removed, and the wound is sutured [1].

The disadvantage of this method is excessive trauma to the tissues of the anterior abdominal wall and time-consuming due to the need to fix the implant with interrupted sutures, as well as the possibility of relapse due to insufficient strength properties of near-defective tissues.

The objective of the invention is to increase the effectiveness of treatment of patients with inguinal hernias by reducing the time spent on surgery and preventing the occurrence of relapse of the disease.

This object is achieved by the fact that in the method of surgical treatment of inguinal hernia, including the separation of the parietal peritoneum, the allocation of the internal opening of the inguinal canal, hernial sac along with its contents to the neck, the external opening of the inguinal canal, excision of the excess hernial sac and immersion of its contents in the free abdominal cavity , the creation of a visualized space adequate to the size of the mesh implant, drainage and suturing of the wound, new is that in the region of the posterior wall of the inguinal canal In the transverse fascia, a mesh nickelide-titanium implant is installed on the area corresponding to the projection of the inguinal and femoral canal; porous fixing plates made of titanium nickelide 0.3-0.5 mm thick are located along the inner and outer edges, the distance between them is 5-10 mm .

The proposed method for the surgical treatment of inguinal hernias allows with the least trauma and time costs to perform plastic surgery of the femoral and posterior walls of the inguinal canal without relapse. Porous titanium nickelide plates allow seamless fixation of the mesh implant. Due to the biochemical and biomechanical compatibility of porous titanium nickelide with body tissues, the connective tissue from the recipient side grows through the porous structure of the fixing plates, forming a connective tissue regenerate that is unified with the implant material, due to which the strength properties of near-defective tissues are enhanced.

The method is as follows. Under the general or local anesthesia in the inguinal region, the skin and underlying tissues are dissected prior to aponeurosis of the external oblique muscle of the abdomen from the anterior superior spine of the iliac wing to tuberculum pubicum, the front wall of the inguinal canal is opened, and leaflets of the aponeurosis are mobilized. The hernial sac is secreted to the neck, opened, its contents are immersed in the abdominal cavity, in the neck area the hernial sac is sutured tightly, the excess is excised. Plastic surgery of the femoral and posterior walls of the inguinal canal is carried out with a mesh nickel-titanium implant; porous fixing plates made of titanium nickelide 0.3-0.5 mm thick, the distance between which is 5-10 mm, are located on the inner and outer edges. The spermatic cord or uterine round ligament is placed in front of the implant. The wound is sutured in layers, drained.

Example. Patient V., 65 years old, was admitted with a diagnosis of repeatedly recurring right-sided inguinal hernia. From the anamnesis: previously operated on three times for a right-sided inguinal hernia. Under local anesthesia, scarred tissues in the right inguinal region were excised. A hernial sac to the neck is isolated, its contents are immersed in the free abdominal cavity, after excision of excess hernial sac is sutured. From the scarred tissue, the medial and lateral sheets of the aponeurosis of the oblique muscle of the abdomen were isolated. A mesh nickel-titanium implant is installed in the projection of the femoral and posterior walls of the inguinal canal, along the inner and outer edges were porous titanium nickelide fixing plates 0.4 mm thick, the distance between which was 6 mm. The spermatic cord is placed in front of the implant. The wound is sutured in layers, drained. The postoperative period was uneventful. The patient was discharged in satisfactory condition. When viewed after 3 years, a relapse of the disease was not detected.

The advantages of the proposed method is that as a result of the use of a mesh nickel-titanium implant with porous titanium nickelide fixing plates located on the inner and outer edges, time costs are reduced, and the invasiveness of the operation is reduced. The dense connective tissue regenerate formed together with the implant material in the projection of the femoral and posterior walls of the inguinal canal and the near-defect region significantly enhances their strength properties, thereby eliminating the possibility of a relapse of the disease.

Clinical trials of the proposed method were carried out on 42 patients. No complications were observed. The method is recommended for practical use.

Sources of information

1. RF patent No. 2187970, M.cl. A 61 B 17/00, 1/313, 2000.

Claims (1)

A method for surgical treatment of inguinal hernias, including the separation of the parietal peritoneum, the allocation of the internal opening of the inguinal canal, hernial sac along with its contents to the neck, the external opening of the inguinal canal, excision of the excess hernial sac and immersion of its contents in the free abdominal cavity, creating a visual space adequate to the size mesh implant, drainage and suturing of the wound, characterized in that in the area of the posterior wall of the inguinal canal in front of the transverse fascia to an area corresponding to For the projection of the inguinal and femoral canal, a mesh nickel-titanium implant is installed, porous fixing plates of titanium nickelide 0.3-0.5 mm thick and a distance between them of 5-10 mm are placed on the inner and outer edges.