RU2253389C1 - Device for carrying out plastic repair of inguinal hernias - Google Patents

Abstract

FIELD: medical engineering.

SUBSTANCE: device has network implant manufactured from super-elastic titanium nickelide wire having notch for placing spermatic cord and member for restricting spermatic cord movements as flat arch-shaped members manufactured from porous permeable titanium nickelide. The arch-shaped members are superimposed over each other with their free ends being arranged in parallel and opposite orientation allowing relative movement to form oval opening. Lumen width of each arch-shaped member is in some proportion to network implant notch width. Individual free end of arch-shaped member makes ratio of 0.25-0.4 relative to said lumen width. The member for restricting spermatic cord movements is usable for being laid over the network implant.

EFFECT: improved consistency of operation.

4 dwg

Description

The invention relates to medical surgical equipment.

Ventral and among them (up to 70%) inguinal hernias are a common pathology of the abdomen. Despite more than a century of history of inguinal hernia treatment, no alternative to surgical intervention has been found. In Europe, in 2000 ~ 1 million hernia operations were performed, in Russia - up to 200 thousand.

The social significance of the problem is given by the specificity of the patient population - mainly men of active and working age with a tendency to hard physical work.

In technical terms, the focus of the problem is the recurrence of the pathology, which explains the huge (over 300) number of known methods of conducting the operation and the urgent desire to improve them. With the stiff edges of an extensive hernia gate, plastic without tensioning the tissues is carried out using cover elements made of biocompatible, elastic sheet materials. Previously, these were ineffective local tissues (autografts), then, with the development of chemistry - synthetic [2] - nets of nylon, polyester, polyethylene, etc. These materials significantly advanced the solution of the problem, however, leaving, for technical creativity, the issue of functional replacement of living tissue. A cardinal step in solving the problem was the use in surgery of ventral hernias of a new class of medical materials - alloys based on titanium nickelide. Due to the similarity of deformation characteristics with those for living tissues, corrosion, and cycle resistance, and a number of other very favorable properties, this material, in addition to the patch function, largely models the behavior of living tissue. Thus, as a material for hernia repair, an alloy based on titanium nickelide turned out to be more biocompatible and functional. It does not cause a prolonged inflammatory reaction, it stimulates the formation of complete connective tissue in the implantation zone and the formation of an anatomically complete abdominal wall.

Various structural forms of devices for inguinal hernia repair are known, for example, in the form of a set of elongated rectangular plates of permeable porous titanium nickelide [3]. The dimensions of the plates allow you to set them in a row on the virtual surface of the hernia gate shelter with endoscopic access to the surgical field. The disadvantage of the analogue is the rigid modeling of the tissue surface with an implant, the fixation of which is carried out due to the surface roughness and adhesion of the plate sections to the tissues in the contact zone.

A known implant for plastic surgery of ventral, including inguinal, hernias made of superelastic nickelidotitan titanium wire in the form of a knitted mesh [4]. The permanent structure of the implant requires open access to the surgical field. This makes it possible to firmly fix the implant with separate interrupted sutures to the muscle-aponeurotic tissues surrounding the hernia gate.

A feature of plastic inguinal hernias is the need for a circular tour of the inguinal canal, where the spermatic cord is located in (men), or the round ligament of the uterus (in women). To do this, in the structure of the mesh implant perform an elongated cutout (figure 1) with a transverse size containing these organs in their cross section. Special fixation of the spermatic cord in the inguinal ring and in the neckline of the implant is not performed, which leaves it possible to migrate, compress, followed by the development of edema of the scrotum and dropsy of the testicle on the side of the operation. Thus, the specified analogue, which is similar in technical essence to a prototype, has a significant drawback.

The technical result of the invention is to increase the solvency of an inguinal hernia operation by organizing fixation of the spermatic cord in the inguinal canal.

The indicated technical result is achieved in that the device for inguinal hernia repair containing a mesh implant of superelastic nickelidotitan filament with a cutout for placement of the spermatic cord is supplemented by a restriction of mobility of the spermatic cord imposed on the mesh implant made of porous permeable titanium nickelide in the form of two flat arcuate elements parallel orientation of the free ends located opposite with the free ends superimposed on each other until an oval holes, and the width of the lumen of each arcuate element is proportional to the width of the cutout of the mesh implant, and the width of the individual free end of the arcuate element is a ratio of 0.25-0.4 with the width of the specified gap.

The technical result is achieved by eliminating the disadvantage of the prototype when using the proposal in the aggregate of essential features.

The mesh implant - the prototype - during the operation is superimposed for plastic surgery of the posterior wall of the inguinal canal without tissue tension. The deep inguinal ring - the concentrator and the fixator of the spermatic cord - has to be formed by pulling together the seams or corrugating the transverse fascia medially from the spermatic cord. In this case, the measure of organization of the optimal clearance of the inguinal ring is determined by the intuition and experience of the surgeon. In the event of an error, it is possible to squeeze the cord and change its normal position. In 45-59% of cases, hernia repair leads to a significant violation of the spermatogenic and hormonal functions of the sex glands.

Introduced into the device, the limiter of mobility of the spermatic cord allows relative movement of the curved elements to select an adequate clearance and precisely position it along the spermatic cord. Since the spermatic cord anatomically when exiting the inner inguinal ring is oriented at an angle to the axis of the latter, the oval is the optimal shape of the hole formed, the dimensions of which are individual. The porous permeable structure of the material allows, due to the roughness of the implant surface, to fix the plates on the underlying tissues without special fastening. Subsequently, they are additionally and reliably fixed by tissues growing in the pores of the material.

The lumen width of a separate arcuate element was chosen for reasons of unrestricted, but rather localized location of the spermatic cord in it, according to the transverse dimension of which the cutout width of the mesh implant was previously selected. The relative width of the free ends of the arcuate elements is determined experimentally from the condition of the sufficiency of the contact area of the arcuate plates with tissues in the place of their application.

The drawings show:

Figure 1. Mesh implant for inguinal canal repair for hernia repair (prototype).

Figure 2. The limiter of mobility of the spermatic cord in accordance with the proposal.

Figure 3. Device for plastic inguinal hernias in the assembly: 1 - mesh implant, 2 - arched elements of the limiter of mobility, 3 - the lumen of the arched element, 4 - the free ends of the arched elements.

Figure 4. The imposition of a limiter of mobility in the region of the internal inguinal ring. Stage of hernia surgery. The structure of the mesh implant is poorly noticeable due to the lack of resolution of the photo equipment.

The attainability of the technical result is confirmed by examples of specific implementation when performing plastic surgery of inguinal hernias in the city clinical hospital No. 8 of Chelyabinsk.

Example.

Patient T., 48 years old. The medical history No. 28115.

Diagnosis: left-sided oblique sliding inguinal-scrotal hernia.

After examining the patient, hernioplasty was performed using the proposed device with the following technical characteristics: mesh implant 1 (Fig. 3) of a nickelidotitanium thread with a diameter of 75 microns of knitted structure with a mesh size of 2-5 mm. Two flat arcuate elements 2 with a clearance of 14 mm, a free end width of 4-5 mm, a plate thickness of 0.5 mm.

The device during the operation was used and works as follows: under endotracheal multicomponent anesthesia, dissection of the aponeurosis allowed access to the inguinal canal. The spermatic cord was mobilized, secreted to the neck and a 15 × 7 cm hernia sac was opened, which descended into the left half of the scrotum. Excess hernial sac after stitching from the inside with a purse string suture was removed. Loose rollers of the transverse fascia are corrugated with rare seams. Plastic surgery of the posterior wall of the inguinal canal with a mesh implant was performed. The spermatic cord is laid in the inguinal canal and is localized in the area of the internal inguinal ring by the mobility limiter (Fig. 4). The excess free ends of the arcuate elements (4) are removed to increase the safety. The aponeurosis of the external oblique muscle of the abdomen is stitched edge to edge.

The postoperative period was uneventful. The pain syndrome is slightly expressed and completely stopped on the fourth day. Quality of life on a Visick scale is rated at 2 points. On the sixth day the patient was discharged in satisfactory condition. The examination in dynamics after 6 months did not reveal signs of relapse and any complaints. A series of 17 similar operations with a successful outcome, surpassing the results of operations with the prototype device in terms of relief of pain and the absence of complications, indicates the industrial applicability of the device.

Sources of information

1. V.D. Bekoev, V.A. Krill, A.A. Troyanov and other inguinal hernia recurrences. // Surgery, 2003, No. 2. p. 45-48.

2. Yu.V. Ivanov. Experience in performing hernioplasty using a polypropylene mesh. Symposium “Actual issues of herniology”, M., 2001, 13.

3, 4. V.A. Zotov. Options for plasty of the abdominal wall with inguinal ventral hernias. The dissertation for the degree of Doctor of Medical Sciences. Novosibirsk state honey. academy. Novosibirsk, 2000, p.126-127, 123.

Claims (1)

Device for plastic inguinal hernia containing a mesh implant made of superelastic nickelidotitan titanium wire with a cutout for placement of the spermatic cord, characterized in that it is additionally equipped with a limiter of mobility of the spermatic cord made of porous permeable titanium nickelide in the form of two flat arcuate elements superimposed on one another the ends when they are parallel and opposite orientation with the possibility of mutual movement to the formation of an oval hole, and the width of the gap Each arcuate element is commensurate with the width of the incision of the mesh implant, and the width of the individual free end of the arcuate element is a ratio of 0.25-0.4 with the width of the specified lumen, while the limiter of mobility of the spermatic cord is made for application to the mesh implant.

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