RU2701895C1 - Method of plastics for inguinal hernia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to hernioplasty. Method involves plastics of the posterior wall of the inguinal canal with the help of a mesh endoprosthesis having a hole and an incision for spermatic cord. Modelled mesh of "titanium silk" is used as a mesh prosthesis. After placing and fixing part of mesh endoprosthesis on internal abdominal oblique muscle second non-fixed part is rolled up to level of hole for spermatic cord and placed on fixed part. Then the spermatic cord is removed medially and upwards. Proposed portion is turned along crimped ligament and fixed to latter.

EFFECT: method enables reducing the time of hernioplasty, reducing the number of postoperative complications associated with excessive traction of the spermatic cord, reducing the risk of recurrent hernias by preserving the initial configuration of the mesh endoprosthesis and free positioning of the endoprosthesis leaf in the area of lumpy ligament.

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Description

The invention relates to medicine, and can be used in departments of general surgery in the treatment of patients with inguinal hernias.

A known method of plasticity for inguinal hernias, including direct access, dissection of the aponeurosis of the external oblique muscle of the abdomen, creating a space under the aponeurosis to accommodate the mesh endoprosthesis, the allocation of the inguinal ligament, spermatic cord, the isolation and processing of the hernial sac, the location of the mesh endoprosthesis, longitudinally dissected from one end underneath spermatic cord, fixation of its lower edge with sutures to the inguinal ligament, medial edge to the pubic tubercle and pyramidal muscle, fixation of the upper edge, stitching of the flaps mesh of the endoprosthesis between themselves and with the internal oblique muscle belly lateral spermatic cord fixation mesh prosthesis to the medial flap aponeurosis abdominal external oblique muscle with its inner side (RF Patent №2371106, IPC A61V 17/00, publ. 2009.)

The disadvantage of this method is the difficulty of positioning the titanium mesh endoprosthesis on the posterior wall of the inguinal canal before fixation, which requires excessive traction of the spermatic cord and, as a result, increases the likelihood of damage to its structures. In the future, this can be expressed in a more severe pain syndrome after surgery, a violation of trophic tissue.

The closest is the method of plasticity for inguinal hernia (RF Patent No. 2398527 IPC A61B 1700, publ. 2010), including plastic surgery of the posterior wall of the inguinal canal using a mesh endoprosthesis having an opening and an incision for the spermatic cord, by suturing the medial edge of the mesh endoprosthesis behind the spermatic cord, to the internal oblique muscle of the abdomen, as well as fixation to the pupartic ligament, placement of the spermatic cord on the mesh, stitching of the edges of the dissected oblique muscle of the abdomen above it.

The disadvantage of this method is that when it is performed using mesh endoprostheses made of titanium threads, the part of the endoprosthesis that is to be fixed to theparticular ligament changes its configuration, being fixed by the free edges of the threads to the surrounding tissues. Attempts to straighten it lengthen the operation time, changing the initial shape of the leaf of the endoprosthesis can lead to a shortage of material to block the necessary areas of the posterior wall of the inguinal canal and, as a result, increase the risk of hernia recurrence.

The task of the invention is to remedy these disadvantages, increase the effectiveness of hernioplasty, reduce intraoperative trauma due to the lack of deformation of the endoprosthesis, reduce the time it takes to complete the operation and simplify the technique of the operation.

To solve the problem with plastic inguinal hernia, including plastic of the posterior wall of the inguinal canal using a mesh endoprosthesis having an opening and an incision for the spermatic cord, by suturing the medial edge of the mesh endoprosthesis behind the spermatic cord to the internal oblique muscle of the abdomen, as well as fixation to the pupartic ligament , placement of spermatic cord on a mesh, stitching of the edges of a dissected oblique muscle of the abdomen above it, it is proposed to use a simulated mesh of titanium silk as a mesh prosthesis but". In this case, after placing and fixing a part of the mesh endoprosthesis on the internal oblique muscle of the abdomen, the second, not fixed part, is rolled up to the level of the opening for the spermatic cord and laid on the fixed part, after which the spermatic cord is retracted medially and upward, the part of the prosthesis rolled up into a roll deployed along the pupartic ligament, fixing to the latter.

The specified technique allows to facilitate the positioning of the titanium mesh endoprosthesis on the posterior wall of the inguinal canal, to avoid its deformation in the process of fixation to the underlying tissues, to place it on the pupartic ligament without changing its configuration, thereby reducing the time for performing the surgical intervention, and to reduce the intraoperative trauma of the surrounding tissues and spermatic cord and also to avoid postoperative complications associated with overextension and deformation of the endoprosthesis.

In FIG. Figure 1 shows a simulation of a titanium endoprosthesis for inguinal hernioplasty

The implementation of the method is shown in a specific clinical example.

Example.

Patient K., 61 years old, was admitted to the surgical department of the Central Clinical Hospital of the Russian Academy of Sciences with a diagnosis of right-sided inguinal hernia. Of the concomitant diseases, obesity of the 2nd degree was noteworthy, which suggested technical difficulties in performing the operation. The large depth of the wound due to excess subcutaneous tissue hindered the surgeon's operative actions during the isolation of the hernial sac.

Under endotracheal anesthesia, after treating the skin three times with an antiseptic solution, a layer-by-layer dissection of the tissues was made by cutting an antiseptic solution parallel to and above 2 cm of the inguinal fold: dissected the skin, subcutaneous fat, aponeurosis of the external oblique muscle of the abdomen, thus opening the inguinal canal and dissecting the external inguinal ring.

The spermatic cord was isolated from the surrounding tissue from the pubic bone to the internal inguinal ring, and was taken to a holder.

Since there was an oblique inguinal hernia, a hernial sac was removed from the elements of the spermatic cord to the inner inguinal ring. After bandaging the neck of the hernial sac, the latter was cut off. (If there was a direct inguinal hernia, then the hernial sac was invaginated into the abdominal cavity). An endoprosthesis made of "titanium silk" was modeled taking into account the need to completely close the posterior wall of the inguinal canal with at least 3 cm overlapping of the internal oblique and transverse abdominal muscles (Fig. 1.). A hole was formed in the endoprosthesis for the spermatic cord.

A simulated endoprosthesis was placed on the posterior wall of the inguinal canal. Its medial edge was fixed to the pubic tubercle with a nodal suture. The spermatic cord was taken down. The medial part of the mesh endoprosthesis was completely straightened and laid on the internal oblique muscle of the abdomen and fixed to it. The non-fixed part of the endoprosthesis was rolled up to the hole for the spermatic cord. The resulting roll was bent, placed on the fixed part. The spermatic cord was moved medially and upward, the area where the roll was placed was exposed, after which the latter was moved to the area of the apartparticular ligament and unrolled along it. The spermatic cord appears in the corresponding hole of the endoprosthesis. The edges of the hole for the sperm were stitched together and sutured to the internal oblique muscle of the abdomen, and also fixed to the pupartic ligament. The endoprosthesis was fixed by stitching with an atraumatic thread on the stitching needle with separate interrupted sutures (possibly also with a continuous suture along the perimeter of the implant or a combination of these sutures). The aponeurosis of the external oblique muscle of the abdomen was stitched over the spermatic cord edge to edge. The surgical wound was sutured in layers.

Using the described technique facilitated the task of positioning the implant on the posterior wall of the inguinal canal under conditions of decreasing the angle of surgical action. The postoperative period was uneventful. The patient was discharged 3 days after surgery. During the follow-up examination after 12 months, no long-term postoperative complications were revealed.

In the surgical department of the Central Clinical Hospital of the Russian Academy of Sciences, 30 hernioplasties of inguinal hernias in men were performed with a titanium mesh endoprosthesis using the proposed method. In all cases, the postoperative period was uneventful, without complications. The follow-up period was 12 months. During this period, there was no clinical data for deformation or displacement of the endoprosthesis. Patients lead an active lifestyle, play sports. There were no relapses in any case.

The proposed method allows to reduce the time the implementation of hernioplasty according to Liechtenstein using titanium mesh endoprostheses; reduces the number of postoperative complications associated with excessive traction of the spermatic cord; reduces the risk of hernia recurrence due to the preservation of the initial configuration of the mesh endoprosthesis and free positioning of the leaf of the endoprosthesis in the area of the pupartic ligament.

Claims (1)

The method of plasticity with an inguinal hernia, including the plasticity of the posterior wall of the inguinal canal using a mesh endoprosthesis having a hole and an incision for the spermatic cord, by suturing the medial edge of the mesh endoprosthesis behind the spermatic cord to the internal oblique muscle of the abdomen, as well as fixing to the pupartic ligament, placing the spermatic cord on the mesh, stitching the edges of the dissected oblique muscle of the abdomen above it, characterized in that a simulated mesh of "titanium silk" is used as a mesh prosthesis, and after that placement and fixation of a part of the mesh endoprosthesis on the internal oblique muscle of the abdomen, the second unrecorded part is rolled up to the hole for the spermatic cord and laid on the fixed part, after which the spermatic cord is retracted medially and upward, the part of the prosthesis rolled up into the roll is deployed along the pupar ligament.

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