RU2294699C2 - Modified plasty of inguinal canal's posterior wall during celotomy - Google Patents

Abstract

FIELD: medicine, abdominal surgery.

SUBSTANCE: one should dissect transverse fascia; the latter together with inferior edge of transverse muscle of abdomen should be sutured up towards iliopubic cord with interrupted sutures up to the narrowing of internal ring of inguinal canal being correspondent to the diameter of spermatic funiculus. Then it is necessary to apply P-shaped intersecting sutures between combined tendon of internal oblique and transverse muscles of abdomen and Poupart's ligament. Onto the bottom developed one should apply the spermatic funiculus, aponeurosis of external oblique muscle of abdomen should be sutured above it edge-to-edge with interrupted sutures. The innovation provides the strength of inguinal canal's posterior wall.

EFFECT: higher efficiency.

4 dwg, 1 ex

Description

Scope: practical public health, namely abdominal surgery.

Analogs of the invention: in the classic monograph by NI Kukudzhanov “Abdominal hernias”, the etiopathogenetic aspects of inguinal hernias are described in detail. The author convincingly proves the leading role of the posterior wall of the inguinal canal in the occurrence of hernias. This is confirmed by the long-term use of various hernioplasty options, among which the Bassini, Postemsky, McVey, Shuldeis methods and others, which strengthen the back wall of the inguinal canal, have firmly taken leading positions.

At the same time, one cannot fail to note the fact that many surgeons were adherents of a certain technique, apply it to all patients, without taking into account the features of the anatomical structures of the inguinal gap. Surgeons are often not considered circumstances such as the duration of the disease, the age of the patient, the size of the hernial protrusion, hernia, plastic properties of the anatomical structures of the inguinal canal.

As a prototype, we took the Shouldice method described in the work.

Description of the prototype. Method Shouldice.

A normal skin incision and aponeurosis of the external oblique muscle of the abdomen are made. The spermatic cord is secreted, taken to the holder and retracted laterally. The hernial sac is isolated and treated, after dissection and detachment of the transverse fascia, the hernial sac is highly bandaged and resected. The transverse fascia is dissected, isolated from adipose tissue. Plastic surgery is performed as follows: the transverse fascia is sutured to the iliac-pubic strand with a continuous suture, then the internal oblique and transverse muscles are taken into the suture and sutured to the inguinal ligament with a continuous suture. The spermatic cord is laid on the formed bed, the aponeurosis of the external oblique muscle is sutured above it edge to edge with a continuous seam as well.

Criticism of the prototype. The disadvantage of the prototype, we consider flashing the transverse fascia to the ileo-pubic cord continuous suture. With the destruction of the posterior wall of the inguinal canal, which is observed in all patients with inguinal hernias, dissection of the transverse fascia with subsequent suturing with a continuous suture to the ileo-pubic cord is not always possible. In addition, the strength of the transverse fascia is insufficient. In this connection, we recommend, after dissection of the transverse fascia, suturing of the latter together with the lower edge of the transverse muscle to the iliac-pubic cords with interrupted sutures. With small hernias, the second stage is the production of typical Bassini plastic surgery. And with large and recurrent hernias, when there are pronounced changes in the transverse and internal oblique muscles of the abdomen, the second stage is the application of U-shaped overlapping sutures between the joint tendon of the internal oblique and transverse muscles of the abdomen to the pupartic ligament. On the formed bed we lay the spermatic cord, and the aponeurosis of the external oblique muscle sew over it edge to edge with interrupted sutures.

The purpose of the invention is to increase the efficiency of surgical treatment of patients with inguinal hernias.

SUMMARY OF THE INVENTION The proposed method consists in the following: opening the inguinal canal, exposing the spermatic cord and processing the hernial sac do not differ from conventional methods. The method is illustrated in FIG. 1, 2, 3, 4, where 1 is the aponeurosis of the external oblique muscle of the abdomen; 2 - spermatic cord; 3 - ileopubic tract; 4 - Cooper bunch; 5 - transverse fascia; 6 - joint tendon of the internal oblique and transverse muscles of the abdomen; 7 - inguinal ligament; 8 - internal oblique muscle of the abdomen; 9 - transverse muscle of the abdomen.

Strengthening of the posterior wall of the inguinal canal is done after dissection of the transverse fascia, the latter, together with the lower edge of the transverse muscle, are sutured to the ilio-pubic strand with interrupted sutures until the inner ring of the inguinal canal is narrowed according to the diameter of the spermatic cord (Fig. 1 1st row of sutures).

With small hernias, the second stage is the production of typical Bassini plastic surgery (Fig. 2, 2nd row of sutures).

And with large and recurrent hernias, when there are pronounced changes in the transverse and internal oblique muscles of the abdomen, the second stage is the application of U-shaped overlapping each other and sutures directed in different directions between the joint tendon of the internal oblique and transverse muscles of the abdomen and the pupar ligament (Fig. 3, 2nd stage).

On the formed bed, the spermatic cord is laid, the aponeurosis of the external oblique muscle is sutured above it to the edge with interrupted sutures (Fig. 4).

An example of a specific implementation of the method.

The operation was performed in patient N., 52 years old, with a large inguinal hernia. The skin, subcutaneous tissue was dissected by a conventional incision. The aponeurosis of the external oblique muscle of the abdomen was isolated and the latter was longitudinally dissected, including the external inguinal ring. From the pubic tubercle, the spermatic cord was mobilized, which was taken to the holder. After revision and reduction of the hernial sac, it was removed with ligation at the neck. The posterior wall of the inguinal canal was strengthened after dissection of the transverse fascia with interrupted sutures by stitching the transverse fascia and the lower edge of the transverse muscle to the iliac-pubic strand until the inner ring of the inguinal canal is narrowed according to the diameter of the spermatic cord after dissection of the transverse fascia.

At the second stage, U-shaped overlapping and directed in different directions sutures between the joint tendon of the internal oblique and transverse muscles of the abdomen were applied to the pupartic ligament. A spermatic cord was placed on the formed bed. The aponeurosis of the external oblique muscle was sutured above it edge to edge with interrupted sutures.

According to this method, 32 operations were performed.

The features of the invention distinctive from the prototype.

1) Hemming the transverse fascia and the lower edge of the transverse muscle to the ilio-pubic cord with interrupted sutures.

2) The imposition of U-shaped overlapping and directed in different directions sutures between the joint tendon of the internal oblique and transverse abdominal muscles to theparticular ligament with large and recurrent inguinal hernias.

Positive effect.

Provides durability of the posterior wall of the inguinal canal.

A positive aspect of the operation is: a favorable course of the postoperative period, mild pain and early patient activation.

The results of a questionnaire survey of patients indicate early rehabilitation and a return to previous employment.

Within 6 months - 1.5 years after surgery, relapses were not observed.

Claims (1)

The method of plasty of the posterior wall of the inguinal canal for large and recurrent hernias during hernia cutting, characterized in that after dissection of the transverse fascia, it, together with the lower edge of the transverse abdominal muscle, is sutured to the ilio-pubic cords with interrupted sutures to narrow the inner ring of the inguinal canal according to the diameter of the spermatic cord, then impose U-shaped intersecting each other and directed in different directions sutures between the joint tendon of the internal oblique and transverse muscles of the abdomen and thepartis ligament, on ized bed laid the spermatic cord, and the aponeurosis of the external oblique abdominal muscles are sutured over it edge to edge with interrupted sutures.

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