RU2748774C1 - Method for laparoscopic treatment of inguinal hernia with large sizes of inner ring of inguine canal in children - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to surgery, herniology. Through the first puncture, extraperitoneally, the first needle with a ligature, held in its lumen in the form of a loop, is injected in relation to the outer edge of the inner ring of the inguinal canal at an angle of 125 degrees outward to the skin surface and passed under the peritoneum. An injection is performed. Then the first needle is removed, and the first loop remains in the abdominal cavity. Through the second puncture, extraperitoneally, the second needle with a ligature held in its lumen in the form of a loop is inserted into the inner edge of the inner ring of the inguinal canal at an angle of 125 degrees inwardly to the skin surface and passed under the peritoneum. The second needle is removed, and the thread in the form of the second loop is placed in the first loop and pulled out. The first needle through the first puncture is subcutaneously passed outward through the second puncture, and the second ligature is inserted into the distal end of the first needle and passed outward through the proximal end. After removal of the needle, the second ligature passed through the first puncture is tied.EFFECT: method reduces the risk of intraoperative and postoperative complications. The method is technically simple and does not require additional special training of the surgeon.1 cl, 10 dwg, 1 ex

Description

The invention relates to medicine, namely to surgical methods for treating inguinal hernias in children.

Known extracorporeal laparoscopic methods of hernia repair for inguinal hernia in children [Prasad R., Lovvorn H.N., Wadie G.M., Lobe T.E. Early experience with needleoscopic inguinal herniorrhaphy in children. Journal of Pediatric Surgery, 2003, No. 38, p. 1055-1058]. After one puncture, the ligature is retroperitoneally encircled around the inner ring of the inguinal canal using a curved awl; [Takehara N., Yakabe S., Kameoka K. Laparoscopic percutaneous extraperitoneal closure for inguinal hernia in children: clinical outcome of 972 repairs done in 3 pediatric surgical institutions. Journal of Pediatric Surgery, 2006, No. 41, p. 1999-2003]. After one puncture, the ligature is retroperitoneally encircled around the inner ring of the inguinal canal using a special Lapaherclosure needle; [Shalaby R.Y., Fawy M., Soliman S.M., Dorgham A. A new simplified technique for needlescopic inguinal herniorrhaphy in children. Journal of Pediatric Surgery, 2006, No. 41, p. 863-867]. After one puncture, the ligature is retroperitoneally encircled around the inner ring of the inguinal canal using a Reverdin needle.

The above methods have serious disadvantages:

- sufficient complexity of technical performance;

- the need for special instruments to perform the retroperitoneal stage of the operation;

- significant complexity of implementation with a large diameter of the inner ring of the inguinal canal;

The known method of laparoscopic hernia repair with inguinal hernia in children [Kim S., Hui T. Laparoscopically assisted repair of inguinal hernia through a micro-incision and extraperitoneal division and ligation of the hernia sac. Pediatric Surgery Inernational, 2013, No. 29, p. 331-334]. Through a micro-incision in the groin, the "mosquito" clamp is inserted into the retroperitoneal space, with the help of which the neck of the hernial sac is pulled out and tied with a ligature. However, this method has several disadvantages:

- technical complexity of execution;

- great trauma of performing the retroperitoneal stage;

- significant complexity of implementation with a large diameter of the inner ring of the inguinal canal;

The closest in technical essence is the "lasso" technique for laparoscopic hernia repair in children [Muensterer OJ, Georgeson K.E. Inguinal hernia repair by singleincision pediatric endosurgery (SIPES) using the hydrodissection-lasso technique, Surgery Endoscopic, 2011, No. 25, p. 3438-3439.]. An extraperitoneal injection of a small volume of saline (NaCl) is performed in the projection of the elements of the spermatic cord. A needle with a ligature, passed into the lumen of the needle in the form of a loop, is inserted from the outside medially from the inner inguinal ring, is passed under the peritoneum, bypassing the components of the spermatic cord, and is punctured laterally from them. The loop remains in the abdominal cavity. A repeated injection of a similar needle, also with a thread threaded into it, which is a hernial ligature, is made on the other side of the inner inguinal ring through the previous puncture. A thread in the form of a loop is placed in the first loop and, pulled out, is tied subcutaneously. This method has several disadvantages:

- sufficient complexity of technical execution;

- the need for hydropreparation of the retroperitoneal space;

- significant complexity of execution with a large diameter of the inner ring of the inguinal canal - the need to turn the straight working instrument (needle) in the process of bypassing the inner ring of the round shape of the inguinal canal starting from 45 degrees and ending with 135 degrees to the skin surface with a straight instrument (needle)

- the risk of damage to the working tool (bending or breaking the needle) during the operation

- risk of damage to soft tissues if it is necessary to displace them with a direct instrument (needle)

The aim of the invention is to improve the results of laparoscopic treatment for inguinal hernia with a large diameter (more than three centimeters) of the inner ring of the inguinal canal in children.

This goal is achieved in that the elimination of the hernial defect with large (more than three centimeters) dimensions of the inner ring of the inguinal canal is carried out by extraperitoneal ligature of two injections at an angle of 125 degrees each to the skin surface, followed by subcutaneous movement of the latter into the first injection.

The method is carried out as follows.

In an operation for an inguinal hernia, after inserting a laparoscopic video camera into the abdominal cavity and visualizing the inner ring of the inguinal canal with a diameter of more than three centimeters (Fig. 1), through the first puncture extraperitoneally, the first needle with a ligature passed into its lumen in the form of a loop is injected into the outer edge of the inner ring of the inguinal canal at an angle of 125 degrees outward to the skin surface (Fig. 2), is carried out under the peritoneum, and punctured, bypassing the components of the spermatic cord. The first needle is removed and the first loop remains in the abdomen. Through the second puncture, extraperitoneally, a second needle with a ligature held in its lumen in the form of a loop is injected tangentially to the inner edge of the inner ring of the inguinal canal at an angle of 125 degrees inwardly to the skin surface (Fig. 3) and passed under the peritoneum, bypassing the spermatic cord components. The second needle is removed. A thread in the form of a second loop is placed in the first loop (Fig. 4) and pulled out (Fig. 5). Then the first needle through the first puncture is subcutaneously passed out through the second puncture (Fig. 6). A second ligature is inserted into the distal end of the first needle (Fig. 7) and pulled out through the proximal end. After removing the first needle, the second ligature is tied through the first puncture (Fig. 8) (Fig. 9). In this case, there is a complete closure of the inner ring of the inguinal canal with the elimination of the inguinal hernia. The ends of the ligature are cut off and the knot is placed under the skin. Skin punctures are treated with an antiseptic and do not require additional suturing (Fig. 10).

An example of a specific application. Patient K., 15 years old. Diagnosis: right inguinal hernia. After placing a laparoscopic video camera into the abdominal cavity and visualizing the right inner ring of the inguinal canal with a diameter of three and a half centimeters, through the first puncture extraperitoneally, the first needle with a ligature passed into its lumen in the form of a loop was injected tangentially to the outer edge of the inner ring of the inguinal canal at an angle 125 degrees outward to the skin surface, held under the peritoneum, and was punctured, bypassing the spermatic cord components. The first needle was removed and the first loop remained in the abdominal cavity. Through the second puncture, extraperitoneally, a needle with a ligature passed into its lumen in the form of a loop was injected tangentially to the inner edge of the inner ring of the inguinal canal at an angle of 125 degrees inwardly to the skin surface and passed under the peritoneum, bypassing the spermatic cord components. The second needle has been removed. The thread in the form of a second loop was placed in the first loop and pulled out. Then the first needle through the first puncture was subcutaneously passed out through the second puncture. A ligature was inserted into the distal end of the first needle and pulled out through the proximal end. After the first needle is removed, the second ligature is tied through the first puncture. In this case, there was a complete closure of the inner ring of the inguinal canal with the elimination of the inguinal hernia. The ends of the ligature were cut off and the knot was placed under the skin. Skin punctures are treated with an antiseptic. The surgery was completed.

This method was used in 12 patients with inguinal hernia and the diameter of the inner ring of the inguinal canal is more than three centimeters. There were no complications and relapses of the disease in the early and late postoperative periods.

Significant differences of the proposed method for laparoscopic treatment of inguinal hernia with large sizes of the inner ring of the inguinal canal in children:

- simplicity of technical execution;

- reducing the risk of intraoperative and postoperative complications;

- the possibility of guaranteed elimination of an inguinal hernia when the size of the inner ring of the inguinal canal is more than three centimeters;

- no additional costs for the implementation of this method of treatment;

- no need for additional special training in the proposed method of treatment.

Claims (1)

A method of laparoscopic treatment of an inguinal hernia with large sizes of the inner ring of the inguinal canal in children, including the installation of a laparoscopic video camera into the abdominal cavity, characterized in that through the first puncture extraperitoneally the first needle with a ligature passed into its lumen in the form of a loop is injected tangentially to the outer edge of the inner ring the inguinal canal at an angle of 125 degrees outward to the skin surface and is carried out under the peritoneum, then an injection is made, bypassing the components of the spermatic cord, then the first needle is removed, and the first loop remains in the abdominal cavity, after which, through the second puncture, extraperitoneally the second needle with a ligature held in its lumen in the form of a loop, injected against the inner edge of the inner ring of the inguinal canal at an angle of 125 degrees inward to the skin surface and carried out under the peritoneum, bypassing the components of the spermatic cord, remove the second needle, and the thread in the form of a second loop is placed in the first loop and taken out, then the first needle through the first puncture, subcutaneously, it is passed out through the second puncture and a second ligature is inserted into the distal end of the first needle and brought out through the proximal end, and after removing the needle, the second ligature brought out through the first puncture is tied, while the inner ring of the inguinal canal is completely closed with the elimination of the inguinal hernia, after which the ends of the ligature are cut off and the knot is placed under the skin with the treatment of skin punctures with an antiseptic without additional suturing.

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