RU2498778C2 - Method for inguinal canal reinforcement in direct inguinal hernia by endoloop-assisted transverse fascia repair - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly herniology. The pre-peritoneal tissues are dissected. The inguinal space elements are separated. An endoloop is placed over on a basis of the transverse fascia extended into the pre-peritoneal space. A mesh endoprosthesis is mounted and fixed.

EFFECT: method enables reinforcing the posterior wall and reducing pain syndrome.

2 ex, 2 dwg

Description

A method of reinforcing the posterior wall of the inguinal canal with laparoscopic hernioplasty of direct inguinal hernias, including plastic surgery of the transverse fascia, characterized in that an endo loop is applied to the base of the transverse fascia elongated into the preperitoneal space.

The invention relates to medicine, namely to herniology, and can be used in the treatment of direct inguinal hernias. Direct inguinal hernias are known to be one of the most complex inguinal hernias. In the literature you can find a huge amount of description of methods for strengthening the posterior wall of the inguinal canal with direct hernias, none of which gives a 100% guarantee against relapse [1]. Hernioplasty with a mesh endoprosthesis of direct inguinal hernias with any technique without eliminating the prolapse of the transverse fascia can lead to unpleasant sensations in the postoperative period, the formation of hematomas and seromas in the formed pocket, due to the presence of prolapse, and also to relapse. With laparoscopic hernioplasty, the most common technique is the plasticity of the transverse fascia by fixing it to the womb with clips. With this technique, the cutting of the transverse fascia with a clip and its inadequate fixation is possible, as well as, according to some reports, the intensification of pain in the postoperative period due to an excess of clips of the pubic bone periosteum [2].

The purpose of the invention: to solve the problem of strengthening the transverse fascia with laparoscopic hernioplasty of direct hernias. The goal is achieved by applying an endo loop to the prolapse of the transverse fascia.

A method of reinforcing the posterior wall of the inguinal canal with laparoscopic hernioplasty of direct inguinal hernias, including performing transverse fascia plasty, characterized in that an endo loop is applied to the base of the transverse fascia elongated in the preperitoneal space and consists of the following: when performing laparoscopic hernioplasty for a direct inguinal hernia, after applying carboxyperitone , the parietal peritoneum is opened above the hernial protrusion by 5 cm, tissue dissection is performed in preperitoneal th space, a hernial sac stands out, elements of the spermatic cord stand out. We find a stretched transverse fascia prolapse in the inguinal space in the projection of the medial inguinal fossa. Then, the bottom of the stretched transverse fascia is pulled into the preperitoneal space (Fig. 1). An endo loop (Fig. 2) is superimposed on the base of the formed cone elongated into the perperitoneal space of the transverse fascia (Fig. 2) and tightened, thereby prolapse of the transverse fascia is eliminated and the posterior wall of the inguinal canal is strengthened. The next step in the preperitoneal space is set and fixed mesh endoprosthesis, followed by its peritonization.

In our opinion, the strengthening of the posterior wall of the inguinal canal of the endo-loop allows us to solve several problems:

1. Strengthen the back wall of the inguinal canal

2. To reduce the severity of pain in the postoperative period associated with the fixation of the transverse fascia to the pubic bone with clips.

Example 1. Patient P., 56 years old, was admitted to the surgical department of the Municipal Clinical Hospital BSMP on 07/12/11 for planned surgical treatment with a diagnosis of right-sided direct inguinal hernia. When viewed in the right inguinal region in the projection of the medial fossa, a tumor-like formation measuring 5 × 5 cm is determined, which is easily corrected into the abdominal cavity. 08/13/11 g under ETN laparoscopic hernioplasty with mesh endoprosthesis. The prolabial section of the transverse fascia in the projection of the hernia is elongated into the preperitoneal space, an endo loop is placed on the neck. The operation is completed by fixing the mesh to the bosom with two clips. The postoperative period without complications. Discharged on the third day. After a month, a follow-up inspection - without features.

Example 2. Patient S., 47 years old, was admitted to the surgical department of the Municipal Clinical Hospital BSMP on 07.27.11 g for planned surgical treatment with a diagnosis of direct inguinal hernia on the left. When viewed in the left inguinal region, a tumor-like formation 4 × 5 cm in size is determined, which is easily corrected into the abdominal cavity. 08/28/11 g under ETN laparoscopic hernioplasty with mesh endoprosthesis. The prolabial section of the transverse fascia in the projection of the hernia is elongated into the preperitoneal space, an endo loop is placed on the neck. The operation is completed by fixing the mesh to the bosom with two clips. The postoperative period without complications. Discharged on the third day. After a month, a follow-up inspection - without features.

Information sources

1. Egiev V.N. Lightweight hernioplasty. - M .: Medical practice - M, 2002; 148.

2. Emelyanov S.I., Protasov A.V., Rutenburg G.M. Endosurgery of inguinal and femoral hernias.- St. Petersburg: Tome, 2000, 176 p.

Claims (1)

A method of strengthening the posterior wall of the inguinal canal with laparoscopic hernioplasty of direct inguinal hernias by performing transverse fascia plasty, characterized in that the tissues are dissected in the preperitoneal space, all the elements of the inguinal gap are selected, an endo loop is placed on the base of the transverse fascia stretched into the preperitoneal space, the mesh is installed and fixed dental prosthesis.

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