RU2636874C1 - Method of umbilical hernia repair in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: through the puncture under the umbillicus under visual and palpatory control, a spinal needle with a nonabsorbable ligature pre-filled into it is guided at a tangent to the hernial sac at the passage point of its vertical part to the horizontal one and the needle is put out through the skin puncture over the umbillicus. The needle is removed, after which a ligature-free needle is guided in a similar manner from the opposite side, and the ligature previously guided from the other side is injected into its distal end and withdrawn through the proximal end outwardly. The spinal needle is removed and the ligature encircled around the hernial sac is tied with complete closure of the hernial sac at the aponeurosis level.

EFFECT: allows to eliminate the defect of the aponeurosis without opening the hernial sac.

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Description

The invention relates to medicine, namely to surgical methods for the treatment of umbilical hernia in children.

Known methods of hernia repair with umbilical hernia [Puri P., Golvart M.E. Atlas of Pediatric Surgical Surgery, Medpress-inform, 2009, p. 160-163]. A semicircular incision is made directly under the navel with a clip secured on both sides of the hernial sac. The latter in the middle third is opened and the existing umbilical ring defect is sutured with separate non-absorbable sutures. The cut off navel is fixed with a separate suture to the aponeurosis [Isakov Yu.F., Stepanov E.A., Krasovskaya T.V. "Abdominal surgery in children", Medicine, 1988, p. 33-34]. An oval incision under the umbilicus or on the side of it gives off an aponeurosis and a hernial sac. The latter in the middle third is opened, stitched, and bandaged at the neck, and removed. Aponeurosis is sutured with single-row or double-row non-absorbable sutures. The skin of the navel is sutured to the aponeurosis [Isakov Yu.F., Lopukhin Yu.M. "Surgery with topographic anatomy of childhood", Medicine, 1989, p. 392-393]. A semicircular incision is made under the navel. The skin is blunt and sharp separated in the form of a flap, to which the distal part of the hernial sac is fixed. The hernial sac is isolated from surrounding tissues, taken to the clamps and opened in the transverse direction in the middle third. The neck of the bag is stitched, bandaged and cut off. The hernia defect is plastic with non-absorbable separate interrupted sutures in the transverse direction along Spitzi.

The above methods have serious disadvantages:

- sufficient complexity of technical performance;

- opening the lumen of the abdominal cavity;

- violation of the anatomical structure in the navel.

A known method of hernia repair with umbilical hernia [Toskin KD, Zhebrovsky V.V. “Abdominal hernias”, Medicine, 1983, p. 162-163]. A semicircular skin incision is made, retreating 1.5 centimeters below the navel. The hernial sac is secured upward from the base and opened in the middle third. Then it is stitched, bandaged and its stump is immersed in the preperitoneal space. Plastic hernia gates carry out separate non-absorbable sutures in the longitudinal direction. However, this method has several disadvantages:

- the risk of relapse due to the stump of the hernial sac below the middle third of the umbilical cord;

- the risk of ligature fistula formation due to a sufficiently large number of non-absorbable sutures used.

The closest in technical essence is the method of hernia repair with umbilical hernia in children [Voilenko V.N., Medelyan A.I., Omelchenko V.M. "Atlas of operations on the abdominal wall and organs of the abdominal cavity", Medicine, 1965, p. 68-70]. A lunar incision is made below the navel. The neck of the hernial sac is isolated, it is opened in the middle third, stitched, bandaged, cut off. A non-absorbable purse string suture is placed on the aponeurosis defect, over which another 3-4 nodal sutures are applied in the longitudinal direction. This method has several disadvantages:

- sufficient complexity of technical performance;

- opening the lumen of the abdominal cavity;

- violation of the anatomical structure in the navel;

- the risk of relapse due to the stump of the hernial sac below the middle third of the umbilical cord;

- the risk of ligature fistula formation due to a sufficiently large number of non-absorbable sutures used;

- the need for suturing a postoperative wound.

The aim of the invention is to improve the results of surgical treatment of umbilical hernias in children.

This goal is achieved by the fact that the aponeurosis defect in the umbilical hernia is eliminated without cutting soft tissues and cutting off the navel by holding a non-absorbable suture around the hernial sac strictly at the level of transition of its vertical part to the horizontal with the help of a spinal needle.

The method is as follows.

After ultrasound examination of the umbilical hernia to clarify the absence of contents in the hernial sac with a pointed scalpel in order to prevent violations of the anatomical structure in the navel, two symmetrical punctures of the skin above and below the navel in the midline are performed. Further, performing traction beyond the center of the skin navel, a hernial sac is pulled in order to prevent infringement of the hernial contents (Fig. 1). Through a puncture under the umbilicus under visual and palpation control, a spinal needle is drawn with a non-absorbable ligature pre-inserted into it along the tangent to the hernial sac strictly at the place where its vertical part becomes horizontal to prevent leaving the non-legged distal part of the hernial sac and the needle is punctured through a skin puncture above the umbilicus (fig. 2). The needle is removed, leaving the ligature carried out with its help (Fig. 3). Next, the needle without ligature is carried out in a similar manner from the opposite side (Fig. 4). The ligature previously carried out on the other side is filled into its distal end and brought out through the proximal end (Fig. 5). After removal of the spinal needle, the ligature circled around the hernial sac is tied (Fig. 6). In this case, the hernia sac completely closes at the level of the aponeurosis (Fig. 7). The knot is immersed under the skin, the ends of the ligature are cut off. Skin punctures are treated with an antiseptic and do not require additional suturing (Fig. 8).

An example of a specific application. Patient P., 6 years old. Diagnosis: umbilical hernia. After ultrasound examination of the umbilical hernia to determine the absence of contents in the hernial sac with a pointed scalpel, 2 symmetrical skin punctures were made above and below the navel in the midline. After traction over the center of the skin umbilicus and pulling the hernial sac through a puncture under the umbilicus, a spinal needle was drawn with a non-absorbable ligature previously inserted into it along the tangent to the hernial sac exactly at the place of transition of its vertical part to the horizontal and the needle was punched through the skin puncture above the umbilicus under the visual and palpation control. After removing the needle and leaving the ligature carried out with its help, the empty needle was drawn in the same way from the opposite side and the ligature was tucked into its distal end with the latter brought out through the proximal part. After removing the spinal needle, the ligature circled around the hernial sac was tied with immersion of the knot under the skin and cutting off the ends of the ligature according to the skin level. Skin punctures were treated with an antiseptic.

This method was used in 138 patients with umbilical hernia. Complications in the early and late postoperative periods were not observed.

Significant differences of the proposed method of hernia repair with umbilical hernia:

- simplicity of technical performance;

- a significant reduction in the time to complete the surgical intervention;

- lack of opening the lumen of the abdominal cavity;

- preservation of the anatomical structure of the navel;

- reduction to a minimum of the risk of relapse;

- reduction to a minimum risk of ligature fistula;

- lack of need for suturing of a postoperative wound.

Claims (1)

A method of hernia repair with umbilical hernia in children, characterized in that after ultrasound examination of the umbilical hernia to clarify the absence of contents in the hernial sac with a pointed scalpel in order to prevent violation of the anatomical structure in the navel, two symmetrical skin punctures are made above and below the navel along the midline with traction for the center of the skin umbilicus and pulling on the hernial sac in order to prevent infringement of the hernial contents, and then through a puncture under the navel under the visual and palpato A spinal needle with a non-absorbable ligature pre-threaded into it is tangent to the hernial sac strictly at the place of transition of its vertical part to the horizontal one in order to prevent leaving the non-ligated distal part of the hernial sac and a needle is punctured through a puncture of the skin over the umbilicus, followed by removal of the last and leaving with its help, ligatures, after which a second needle without ligature is carried out in the same way on the opposite side and tucked into its distal end the ligature previously drawn from the other side and brought out through the proximal end to the outside, after which the spinal needle is removed and the ligature circled around the hernial sac is tied with a complete closure of the hernial sac at the aponeurosis level, followed by cutting off the ligature ends and immersing the knot under the skin, treating skin punctures with an antiseptic.

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