RU2269951C2 - Method for surgical treatment of inguinal hernias - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: one should dissect cross-sectional fascia, remove hernial sac, suture up a combined tendon of lateral abdominal muscles and cross-sectional fascia in median area to lacunar ligament by keeping its loose edge, apply interrupted sutures onto the rest loose edges of cross-sectional fascia, in lateral area it is necessary to suture up tendinous part of cross-sectional muscle to inguinal ligament. The innovation suggested enables to avoid interposition of underlying tissues and prevent tissue tension.

EFFECT: higher efficiency of surgical treatment.

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Description

The invention relates to medicine, in particular to surgery, and can be used in the surgical treatment of inguinal hernias.

Known methods for the surgical treatment of inguinal hernias - according to Bassini, Goldis, Postemsky, which consist in strengthening the posterior wall of the inguinal canal. (Inguinal hernia. Edited by N.I. Kukudzhanov. M., "Medicine", 1969, S. 161-162, 181).

The disadvantage of these methods is that with plastic surgery according to Bassini and Goldis, the lateral abdominal muscles are sutured all the way to the inguinal ligament, which leads to their atrophy, cicatricial degeneration and impaired function. With plastic surgery according to Postemsky, the inguinal canal is eliminated, and the spermatic cord is located in the subcutaneous tissue, which then leads to its dystrophic change.

According to the closest technical essence, as a prototype, we have chosen the method-I of surgical treatment proposed by N.I. Kukudzhanov. The method consists in strengthening the posterior wall of the inguinal canal by suturing two U-shaped sutures in the lateral part of the inguinal space from below through the posterior upper part of the inguinal ligament, and from above through the transverse fascia along with the aponeurosis of the transverse muscle. In the medial part of the inguinal space, the deep leaf of the vagina of the rectus abdominis is sutured to the Cooper ligament.

The disadvantage of this method is the tension of tissues in the medial part of the inguinal gap and the ingress of underlying tissues into the interposition, which in many cases leads to relapse.

The objective of the invention is to reduce the number of relapses in the surgical treatment of inguinal hernias by preventing the underlying tissues from entering the interposition.

The problem is solved in that after dissection of the transverse fascia and removal of the hernial sac in the medial region of the inguinal gap, the joint tendon of the lateral abdominal muscles and transverse fascia are sutured, leaving its free edge, then Cooper’s ligament and inguinal-aponeurotic cord, while also leaving free edge of transverse fascia. Nodal sutures are superimposed on the free edges of the transverse fascia.

A method of surgical treatment of inguinal hernia is as follows: parallel to the inguinal ligament, the skin with subcutaneous fat is dissected. After that, the aponeurosis of the external oblique muscle of the abdomen (the front wall of the inguinal canal) is dissected.

The spermatic cord or the round ligament of the uterus is necessarily taken on the holder. The hernial sac is secreted and removed in the traditional way. In the presence of an oblique inguinal hernia in the medial part of the inguinal gap, the transverse fascia is cut parallel to the inguinal ligament for 2-3 cm.With a direct inguinal hernia, this manipulation is not necessary, since the fascia is dissected when the hernia sac is excreted. Fiber and the external iliac vessels move laterally with the index finger of the left hand or Buyalsky's spatula. In the medial section of the inguinal space, 3 sutures are applied with a round small needle with silk ligature No. 5. The joint tendon of the lateral abdominal muscles and the transverse fascia are stitched from above, leaving its free edge. The Cooper ligament and the ilio-pubic cord are stitched from below, leaving the free edge of the transverse fascia. Nodal sutures are applied to the free edges of the transverse fascia, which are immediately tied. In the lateral part of the inguinal space, the tendon of the transverse muscle is sutured to the inguinal ligament. Sutures are tied, starting from the medial part. If there is tension before suturing, a laxative incision is made on the deep leaf of the vagina of the rectus abdominis muscle.

The salient features of the claimed method are:

1. Hemming in the medial part of the inguinal gap of the joint tendon of the lateral abdominal muscles and transverse fascia, leaving its free edge to the Cooper ligament.

2. Additional flashing, in the medial part of the inguinal space, of the inguinal-aponeurotic cord, leaving a free edge.

3. The imposition of nodal joints on the remaining free edges of the transverse fascia.

The set of essential distinguishing features is new and allows you to strengthen the back wall of the inguinal canal and prevent the underlying tissues from getting into the interposition, which ensures the formation of connective tissue structures between homogeneous tissues and reduces the number of relapses.

Example 1, and b # 3902.

Patient M., 78 years old, was admitted to the hospital with a diagnosis of left-sided recurrent inguinal hernia. Operated in a planned manner 03/19/02. After infiltration anesthesia, the skin was cut with subcutaneous fat parallel to the inguinal and higher by 3 cm of the inguinal fold. Dissected aponeurosis of the external oblique muscle of the abdomen. A hernial protrusion was revealed in the projection of the medial fossa, 12 × 10 × 10 cm in size. A transverse fascia, subserous membrane was dissected above the hernial protrusion. The hernial sac is selected to the neck, stitched, bandaged and cut off. Excised excess fascia fascia. In the medial region of the inguinal space, three sutures were made with a round small needle with silk threads No. 5. The joint tendon of the lateral abdominal muscles and transverse fascia are stitched from above, leaving its free edge. Cooper’s ligament and iliac-pubic cord are stitched from below, leaving a free edge. On the free edges of the transverse fascia superimposed nodal joints with immersion of underlying tissues. In the lateral part of the inguinal space, the tendon of the transverse muscle is stitched from above, the inguinal ligament is from below. Suturing began with the medial part of the inguinal gap, after performing a laxative incision in the medial section of the deep leaf of the vagina of the rectus abdominis muscle. The aponeurosis of the external oblique muscle of the abdomen is sutured with interrupted sutures edge to edge. The wound is sutured in layers. The patient was discharged in satisfactory condition on the 8th day, to date, no complaints, no relapse.

Example 2, and \ b No. 12091.

Patient V., 71 years old, was admitted to the hospital with a diagnosis of bilateral oblique inguinal hernia, prostate adenoma. Operated in a planned manner 10.09.02 under endotracheal anesthesia. An arcuate incision was made above the bosom. Dissected anterior wall of the inguinal canals. Spermatic cord taken to the holder. On the right, the hernial sac is isolated from the elements of the spermatic cord with dimensions of 8.0 × 4.0 × 4.0 cm, stitched at the neck, bandaged and cut off. On the left, the hernial sac is isolated from the elements of the spermatic cord with dimensions of 15.0 × 15.0 × 10.0 cm, stitched at the neck, tied up and cut off. In the medial corner of the inguinal gap, the transverse fascia is dissected on the right and left, the Cooper ligament is highlighted. On the right, in the medial region of the inguinal space, three sutures were placed with a round small needle with silk threads No. 5. The joint tendon of the lateral abdominal muscles and transverse fascia are stitched from above, leaving its free edge. Cooper’s ligament and iliac-pubic cord are stitched from below, leaving a free edge. On the free edges of the transverse fascia superimposed nodal joints with immersion of underlying tissues. In the lateral part of the inguinal space, the tendon of the transverse muscle is stitched from above, and the inguinal ligament is from below. Suturing began with the medial part of the inguinal gap, after a laxative incision was made in the medial section of the deep leaf of the vagina of the rectus abdominis muscle. The aponeurosis of the external oblique muscle of the abdomen is sutured with interrupted sutures edge to edge. Similar manipulations are performed on the left. The wound is sutured in layers. Discharged in satisfactory condition on the 9th day. After surgery, the patient was examined three times. There are no complaints or relapses.

Example 3, and No. 6305.

Patient Yu., 72 years old, was admitted to the hospital with a diagnosis of right-sided direct inguinal hernia. An objective examination revealed a bilateral inguinal hernia. Operated in a planned manner on 15.04.01 under endotracheal anesthesia. An arcuate incision was made above the bosom. Dissected anterior wall of the inguinal canals. The round ligaments of the uterus are taken on holders. Hernial sacs revealed in the projection of the medial inguinal fossa. The transverse fascia is dissected parallel to the inguinal ligament. Dissected subserous membrane. A hernial sac was allocated on the right with dimensions of 8.0 × 8.0 × 6.0 cm, stitched at the neck, bandaged and cut off. A hernial sac was isolated on the left with dimensions 4.0 × 4.0 × 5.0 cm, stitched at the neck, bandaged and cut off. On the right, in the medial region of the inguinal space, three sutures were placed with a round small needle with silk threads No. 5. The joint tendon of the lateral abdominal muscles and transverse fascia are stitched from above. The Cooper bunch is stitched below. In the lateral part of the inguinal space, the tendon of the transverse muscle is stitched from above, the inguinal ligament is from below. Suturing began with the medial part of the inguinal space. Plastic surgery of the anterior wall of the inguinal canal is performed according to Martynov. Similar plastic is made on the left. The wound is sutured in layers. The patient was discharged in satisfactory condition. After 6 months, a relapse of a left-sided inguinal hernia was revealed.

The claimed method was tested on 34 patients with unilateral inguinal hernias and 14 patients with bilateral inguinal hernias.

The results of surgical treatment in 65 patients after the removal of a unilateral inguinal hernia with plastic surgery according to Kukudzhanov were analyzed.

The claimed method allows to prevent the ingress of tissues into interposition, which ensures the formation of connective tissue structures between homogeneous tissues and reduces the number of relapses by 9%.

After plastic surgery by the claimed method, relapse has not yet been identified in any patient. According to the prototype method, 65 relapses were detected in 65 patients, which is 9%.

Claims (1)

A method of surgical treatment of inguinal hernia, including dissection of the transverse fascia, removal of the hernial sac and suturing of tissues in the medial region of the inguinal gap to the Cooper ligament, and in the lateral region of the tendon of the transverse muscle to the inguinal ligament by suturing, characterized in that the joint is hemmed in the medial region the tendon of the lateral abdominal muscles and the transverse fascia with its free edge remaining, with nodal sutures being applied to the remaining free edges of the transverse fascia.