RU2705463C1 - Method for fixation of testis in scrotum with cryptorchidism in children - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely pediatric surgery. Incision is made on the boundary between the skin of the scrotum and the inguinal canal. Surrounding tissues are used to mobilize the testis and spermatic cord maximally to the outer ring of the inguinal canal. That is followed by forming a "cuff" of perine subcutaneous fat by alternately applying separate interrupted sutures above and under the spermatic cord in the direction from the external inguinal ring to the scrotum. That is followed by forming a bed in the scrotum, in which a testicle is lowered, and scrotum skin is closed.EFFECT: method enables reliable testicular fixation in the absence of a fleshy coating, reduces the number of cryptorchidism recurrences without disturbing reticular haemodynamics in the postoperative period, providing an excellent cosmetic result.1 cl, 1 ex, 4 dwg

Description

The invention relates to medicine, in particular to pediatric surgery, pediatric urology, and can be used in the surgical treatment of children with cryptorchidism.

Currently, a large number of methods for fixing the testicle with cryptorchidism are described, but many of them are far from perfect. Over time, among the pediatric urologists and surgeons, the most popular is the method of fixation according to Petrivalsky-Shemaker (ES Shakhbazyan. Cryptorchidism and its treatment. M: Medgiz, 1957, p. 88).

A known method of fixation of the testicle with cryptorchidism according to the Petrivalsky-Shemaker method, based on the fact that an incision is made in the inguinal region to mobilize the testicle, then a tunnel is formed from the inguinal canal to the scrotum. Cut the skin of the bottom of the scrotum to the fleshy membrane. In a dull way, the meaty membrane is separated from the skin, a bed for the testicle is formed. The fleshy membrane is dissected and through the hole in it the testicle is removed in the bed under the skin. The defect of the fleshy membrane is narrowed by separate sutures. The skin wound is sutured over the testicle. In modern children's andrology, the Shemaker operation with cryptorchidism is successfully and universally used in the Russian Federation and abroad. The method involves two incisions in the groin and scrotum. Inguinal access provides adequate visualization during isolation of the vaginal process of the peritoneum and mobilization of the elements of the spermatic cord to lower the testicle into the scrotum and fix it without excessive tension. The disadvantages of this method is that the testicle is located non-physiologically under the skin, the scrotum and the testicle are carried out without visual inspection, the fixation of the testicle is unstable, which often leads to the displacement of the testicle with the bottom of the scrotum towards the inguinal canal. An additional cosmetic drawback of the method is the presence of two cuts.

Using the Bianchi technique (scrotal access), proposed in 1989 (A. Bianchi and B.R. Squire.) Allows to increase the cosmetic result of the testicular fixation method for cryptorchidism using the Petrivalsky-Shemaker method. Despite the high cosmetic result of scrotal orchidopexy, there remains a problem with the method of fixation of the testicle. There is also a method of fixing the testis and spermatic cord in the scrotum with cryptorchidism (RF patent No. 2371110, published October 27, 2009). The method consists in the fact that by cutting the scrotum skin from the base to the bottom of the scrotum through all layers and further forming the testicular bed and spermatic cord, followed by suturing in the corners of the wound, the central tissue is stupidly diluted by the size of the testicle, and at the base it is bred to the inguinal canal, and at the bottom of the scrotum for the testicle bed, then the testicle is laid down in the bed, sutured to the fleshy membrane, forming a testicle bed and a channel for the spermatic cord, and sutures on the skin.

The known method of fixing the testis and spermatic cord in the scrotum with cryptorchidism has a significant drawback. When performing an incision on the scrotum and mobilization of the testicle, there is often a violation of the blood supply and the destruction of the testicular meaty, which makes it difficult to fix the testicle.

The objective of the invention is to provide reliable fixation of the testis when using scrotal orchidopexy.

This problem is solved by the fact that by cutting at the border between the skin of the scrotum and the inguinal canal, the testis and spermatic cord are mobilized to the outer ring of the inguinal canal from the surrounding tissues. After this, the formation of the “cuff” from the perineal subcutaneous fat is performed by alternately applying separate nodal sutures above and below the spermatic cord in the direction from the external inguinal ring to the scrotum. Then, a bed is formed in the scrotum, into which the testicle is lowered and scrotal skin is sutured.

The technical result of the method is the ability to perform reliable fixation of the testis in the absence of a fleshy membrane, as well as simplicity and ease of execution of the method, painless postoperative period.

The invention is illustrated by photographs, where

photo 1 shows a mobilized testicle with elements of the spermatic cord;

photo 2 shows the formed “cuff” of perineal fiber for fixation of the testis;

photo 3 shows the formed bed in the scrotum for the reduction of the testicle;

photo 4 shows the final view of the scrotum after the testicle has been reduced.

The method of fixation of the testicle in the scrotum with cryptorchidism in children is as follows.

Under mask anesthesia in the position of the child on the back, an incision of about 2-3 cm is performed at the border of the skin of the scrotum and the skin of the inguinal region. In a dull and sharp way, the testicle and spermatic cord elements are mobilized as far as possible to the outer ring of the inguinal canal by dissecting the muscle that raises the testicle and secreting the vaginal process of the peritoneum when it is not fused, followed by its ligation. After the implementation of orchidofuniculolysis, the cuff is formed from the perineal fiber by applying individual nodal sutures from the absorbable suture material 4/0 or 5 \ 0 alternately above and below the elements of the spermatic cord. Then a mosquito clamp is used to form a bed in the scrotum, which is sufficient in volume to lower the testicle. After the testicle is reduced, hemostasis is controlled and individual nodal sutures are applied to the skin.

A method of fixing the testicle in the scrotum in cryptorchidism in children is presented by a clinical example.

Patient A., 2 years. Diagnosis: Cryptorchidism on the right inguinal retention.

Due to the absence of the right testicle in the scrotum from birth, the mother of the child was consulted by a pediatric urologist andrologist of the uroandrological department of the GBU RO CSTO in Rostov-on-Don. Upon examination of the patient, the diagnosis was established: Cryptorchidism on the right inguinal retention. The patient was hospitalized as planned in the uroandrological department of the GBU RO CSTO in Rostov-on-Don for surgical treatment. Under operating conditions under mask inhalation anesthesia, after processing the surgical field with an antiseptic solution and a scalpel, an incision was made up to 3 cm at the border between the scrotum skin and the lower edge of the inguinal canal on the right. In a dull and sharp way, the testicle and spermatic cord were mobilized to the border of the outer ring of the inguinal canal. The vaginal process of the peritoneum is separated from the elements of the spermatic canticle, stitched with a thin capron at the base and cut off. Using perineal fiber, a “cuff” is formed by applying separate nodal sutures above and below the elements of the spermatic cord towards the scrotum. Suture material Vikril 4/0 on a round needle, needle size 17 mm. Then a mosquito clamp is used to form a bed in the scrotum, which is sufficient in volume to lower the testicle. The testicle is immersed in the formed bed. Control of hemostasis and the application of individual nodal sutures on the skin. The seam line was treated with an antiseptic solution and an aseptic dressing was applied. The operating time was 28 minutes. The postoperative period was uneventful. Anesthesia was not required. When examining the patient the next day, overall health is satisfactory when ligation of the right testicle in the scrotum. The patient was discharged the day after surgery. Parents of the child appreciated the cosmetic result of the operation perfectly. When viewed after 1, 3, 9 months, the reduced right testicle is located in the scrotum. According to the ultrasound of the scrotum, an increase in testicular tissue of the right testicle is recorded in dynamics.

A total of 124 patients were operated using this method. Relapses of cryptorchidism were not detected.

The method allows reliable fixation of the testicle in the scrotum with cryptorchidism in children, performing reliable fixation of the crotch-fatty tissue in the absence of a fleshy membrane, thereby providing an excellent cosmetic result and reducing the number of relapses of cryptorchidism.

Claims (1)

The method of fixation of the testicle in the scrotum during cryptorchidism in children, characterized in that by cutting at the border between the skin of the scrotum and the inguinal canal from surrounding tissues, the testicle and spermatic cord are mobilized to the outer ring of the inguinal canal, then a “cuff” is formed from the perineal subcutaneous fat cellulose by alternately applying separate nodal sutures above and below the spermatic cord in the direction from the external inguinal ring to the scrotum, after which the scrotum forms a bed in which the testicle is lowered, and ivayut the skin of the scrotum.

Images