RU2257159C2 - Method for treating inguinal and femoral hernias - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: one should cover hernial porta with elastic netting out of nonabsorbable polymeric material. This netting has got a foramen for spermatic funiculus and a groove for it. One should perform a protrusion at lower edge at median edge of netting to close lacuna of lymphatic gland, fix superior edge of netting towards anterior surface of internal oblique muscle of abdomen, fix inferior edge of protrusion towards pectineal fascia and surface fibers of pectineal muscle, fix median edge of protrusion and superior median edge of netting to the sheath of rectus muscle of abdomen, fix inferior edge of netting to Poupart's ligament, fix netting additionally along the whole surface towards anterior surface of cross-sectional fascia of abdomen.

EFFECT: increased reliability in closing hernial porta.

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Description

The invention relates to medicine used to close inguinal and femoral hernias.

A known preperitoneal method for eliminating inguinal and femoral hernias, including plastic surgery of the posterior wall of the inguinal canal by stitching with the U-shaped sutures of the tendons of the internal oblique and transverse muscles, the outer edge of the vagina of the rectus muscle with the scallop ligament, and creating duplicate transverse fascia with interrupted sutures with restoration of the inguinal canal (1) .

The disadvantages of the method are the complexity of the operation, as well as the use of technology with tension of stitched tissues for plastic inguinal gap.

There is also a known method of closing hernial gates according to Liechtenstein. In this case, the inguinal canal is opened, hernia repair is performed, and the hernial defect is sutured using an elastic mesh made of non-absorbable material, the lower edge of which is fixed to the pupartic ligament, and the upper edge to the front surface of the internal oblique muscle of the abdomen. The operation is effective for oblique and direct inguinal hernias (2, 3).

The disadvantage of this method is the low effectiveness of treatment with a combination of inguinal and femoral hernias.

This method is taken as a prototype, since it involves opening the front wall of the inguinal canal and using a polypropylene mesh fixed to the front surface of the internal oblique muscle and to the pupartic ligament in plastic hernia defects.

The aim of the invention is to improve the results of treatment of patients with inguinal and / or femoral hernias.

This goal is achieved by the fact that the mesh has an opening for the spermatic cord and a slot for it, is performed on the lower edge, at the medial edge of the mesh, the protrusion closing the lacuna of the lymphatic gland, fix its edge to the scallop fascia and superficial fibers of the scallop muscle, fix its medial edge and the upper medial edge of the mesh to the vagina of the rectus abdominis muscle, the mesh is additionally fixed over the entire surface to the front surface of the transverse fascia of the abdomen.

The method of the invention is illustrated in graphic material.

Figure 1 shows a pattern of a polypropylene mesh or mesh of any non-absorbable or long-absorbable polymer materials A, prepared for plastic hernia gate, where on its lateral side B there is a hole C for the spermatic cord and a cut to it G. On the lower edge D of the mesh at the medial edge G there is a protrusion And, sufficient to close the gap of the lymphatic gland, by an average of 6 cm. All corners of the grid are rounded, and the grid can be made of any other non-absorbable material or of poly ernogo material with long periods of resorption - a few months or years.

Figure 2 shows a side section of the inguinal canal at the level of fixation of the polypropylene mesh to the scallop fascia and scallop muscle, where 1 is the peritoneum, 2 is the preperitoneal fiber, 3 is the transverse fascia, 4 is the transverse muscle, 5 is the internal oblique muscle, 6 is the aponeurosis external oblique muscle of the abdomen, 7 - spermatic cord, 8 - pupartic ligament, 9 - scallop ligament, 10 - scallop muscle, A - polypropylene mesh, 11 - subcutaneous tissue, 12 - skin, 13 - fixation of the upper edge of the mesh to the front surface of the internal oblique muscle of the abdomen, 14 - fixation of the lower edge of the mesh and to the pupartic ligament, 15 - fixation of the mesh with separate sutures along its entire surface to the anterior surface of the transverse fascia, 16 - fixation of the mesh to the scallop ligament, 17 - fixation of the mesh to the scallop muscle, 18 - sutures on dissected leaves of the aponeurosis of the external oblique muscle of the abdomen, 19 - sutures on subcutaneous tissue, 20 - sutures on the skin.

The method is used as follows. A skin incision of 8-12 cm 2 cm higher and parallel to the pupartic ligament open the front wall of the inguinal canal. In the inguinal gap, a hernial sac is found, which is secreted to the neck, stitched, bandaged and cut off, the defect in the transverse ligament is sutured with separate interrupted sutures, and the dissected cremator is restored. The cremator tube with the spermatic cord is lifted from the depths of the wound with the help of holders and pulled back. The upper edge of the polypropylene mesh A is fixed to the front surface 13 of the internal oblique muscle 5, the entire surface of the mesh is fixed 15 to the transverse fascia 3 along separate seams, the protrusion of the mesh And at its medial edge Ж is fixed 16 to the scallop fascia 9 and to the surface fibers 17 of the scallop muscle 10, to the back sheet of the vagina of the rectus abdominis muscle. The lower edge of the mesh is fixed 14 to the pupartic ligament 8. On the lateral edge of the mesh B, a hole B is cut corresponding to the diameter of the spermatic cord 7. After holding the spermatic cord through a hole in the mesh, several sutures are applied to the mesh defect G at the lateral edge B from the spermatic cord. When fixing the mesh, threads from non-absorbable material are used and / or alternated with threads from material with long absorption times. The spermatic cord 7 is laid on a polypropylene mesh A, 18 the previously dissected aponeurosis of the external oblique muscle of the abdomen 6 is sutured, 10 subcutaneous tissue 11 is sutured, and 20 skin 12 is sutured.

The method was applied in 2 patients.

Example 1. Patient R., 43 years old, and / b 965 03/31/03 in the central city hospital of the city of Novokuybyshevsk, Samara region, operated on for a right-sided oblique inguinal hernia. Plastic surgery of the posterior wall of the inguinal canal was done according to the described method using a polypropylene mesh manufactured by Ethikon. There were no complications after the operation, on April 6, 2003, all sutures were removed, the wound healed by first intention, was discharged for outpatient treatment on April 7, 2003.

Example 2. Patient K., 67 years old, and / b 1919 03/31/03 in the central city hospital of Novokuybyshevsk, Samara region, operated on for a right-sided direct inguinal hernia. Plastic surgery of the posterior wall of the inguinal canal was done according to the described method using a polypropylene mesh manufactured by Ethikon. There were no complications after the operation, on April 8, 2003, all sutures were removed, the wound healed by first intention, and on April 11, 2003, he was discharged for outpatient treatment.

The proposed method for the treatment of patients with inguinal and femoral hernias is simple and reliable. There are no complications associated with the operation. The method can be widely used in urban and regional general surgical departments in the treatment of patients with inguinal or femoral hernias.

Sources of information

1. Klebanov A.N., Rybakov M.S., Ostroukhov N.F. The simultaneous elimination of bilateral inguinal and femoral hernias. Surgery. 1998, No. 4, S.51-52.

2. Egiev V.N., Chizhov D.V., Rudakova M.N. Plastic surgery according to Liechtenstein for inguinal hernias. Surgery. 2000, No. 1, S.19-21.

3. Lichtenstein I.L., Shulman A.G., Amid P.K. The tension-free hemioplasty. Am. J. Surg., 1989; 157: 188-193.

Claims (1)

A method of treating inguinal and femoral hernias, comprising closing the hernial portal with an elastic mesh of non-absorbable polymeric material by fixing its lower edge to theparticular ligament and the upper to the front surface of the internal oblique muscle of the abdomen, characterized in that the mesh has an opening for the spermatic cord and a slot for it perform on the lower edge near the medial edge of the mesh a protrusion covering the lacuna of the lymphatic gland, fix its lower edge to the scallop fascia and superficial fibers of the scallop muscle, fixing t medial its upper edge and a medial edge of the mesh to the vagina the muscles of the rectus abdominis, the mesh further fixed on the whole surface to the front surface of the transverse abdominal fascia.

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