RU2798700C1 - Method of surgical treatment of cryptorchidism with immobilization of the scrotum after orchidopexy in children - Google Patents

Abstract

FIELD: medicine; urology.

SUBSTANCE: device with slots for an elastic band located on a plastic case is applied to the scrotum. The medial surface of the case has the shape of a bowl with perforations containing transitions to the wings located laterally. The device is fixed in such a way that the perforated part of the inner surface of the case bowl covers the scrotum, and the lateral wings are adjacent to the medial surfaces of the lower extremities and are fixed by means of an elastic band enveloping the lower extremities. After 3 days, the device is removed.

EFFECT: method is easy to use, improves the course of the postoperative period during orchiopexy for cryptorchidism, due to reliable immobilization of the scrotum to the patient's lower extremities, reduces skin tension in this anatomical region and accelerates healing.

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Description

The invention relates to medicine and medical technology, namely to pediatric surgery, and is intended to improve the surgical treatment of cryptorchidism in children.

A known method of fixing the testicle in the scrotum with cryptorchidism in children, in which an incision is made at the border between the skin of the scrotum and the inguinal canal, from the surrounding tissues, the testicle and spermatic cord are mobilized as far as the outer ring of the inguinal canal, then a “cuff” is formed from the perineal subcutaneous fat fiber by alternately applying separate interrupted 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 the skin of the scrotum is sutured [EN 2705463 C1, IPC A61B17/00, publ. 2019]. EFFECT: method enables reliable fixation of the testis in the absence of the tunica tunica, reduces the number of relapses of cryptorchidism without disturbing reticular hemodynamics in the postoperative period, providing an excellent cosmetic result.

In the surgical treatment of cryptorchidism after bringing down the testicle, increased attention is paid to its fixation in the scrotum, since various postoperative complications can be observed, the largest number of which is noted when the testicle in the scrotum is fixed with a pronounced tension of the elements of the vas deferens. As a result of such fixation (in 29.1% of orchiopexies), the testicles can be drawn into the inguinal canal, which leads to a relapse of the disease [Panchenko I.A., Shipilov A.I. Surgical tactics for the treatment of cryptorchidism in a specialized uroandrological center. Andrology and genital surgery. 2013. No. 2. S. 46-50].

Currently, testicular retraction can be prevented by securely fixing the scrotum with the retracted testicle. However, there are no special medical devices on the modern market that provide reliable immobilization of the scrotum after such a surgical intervention, and therefore various types of dressings and suspensories are used, which are not able to provide the proper fixing effect.

Known inguinal-scrotal bandage on a hard belt [RU 91850 U1, publ. 2000], containing a suspensorium (a linen bag made of dense soft tissue according to the size of the scrotum), which is supported by two straps passing through the crotch along the buttocks and rising to the waist along the sides, and fastened to a prosthetic or any other hard belt.

It is also known a device for temporary immobilization of the scrotum [RU 2380063 C1, IPC A61F 5/40, publ. 27.01.10], including a suspensorium and its fastening elements on the human body, while the suspensorium is made in the form of a basket, consisting of a lower arc located in the frontal plane and an upper arc rigidly connected to it, located at an angle of 130-135 ° with respect to lower arc and oriented, respectively, with bulges up and down, and three arcs, one central and two lateral, forming a basket niche and oriented anteriorly with bulges, while the central arc is rigidly fixed at one end at the inflection point of the upper arc, and at the other end is rigidly fixed at the point the inflection of the lower arc, the side arcs are rigidly fixed with one end, respectively, on the upper arc, and the other on the lower one in the middle of the distance between the attachment points of the central arc to the upper and lower arcs and their connection points, in addition, at the connection points of the upper and lower arcs, they are rigidly fixed fastening elements made in the form of fixing arcs oriented with a convexity upwards, while at the points of their inflection there are arcuate protrusions 5-6 cm wide and 2-3 cm high, in addition, both fixing arcs are fixed at an angle of 70-75 ° with respect to top arc.

Various suspensions are known [US Patent No. 722121, publ. March 3, 1903, US Patent No. 995600, publ. 06/20/1911, US Patent No. 1030224, publ. 06/18/1912, US Patent No. 1230451, publ. 06/19/1917, US Patent No. 1294709, publ. 02/18/1919], having in their design a belt with supporting straps that fix a kind of basket (or bowl) covering the scrotum.

It is also known protective device [US Patent No. 4134400, publ. 01/16/1979], containing a belt, straps and a rigid cup applied to the scrotum.

A common disadvantage of these devices is the method of their fastening on the patient's body, namely on the waist, which does not block the displacement of the skin of the lower extremities relative to the scrotum, since the principle of fixation used in these devices is based on the delimitation of the testicles without restriction of movement, which can adversely affect the course of early the postoperative period when performing orchiopexy for the correction of cryptochism, especially when the scrotum is sutured to the skin of the inner surface of the thigh (in the presence of a large tension of the elements of the vas deferens).

Based on this, the present invention is based on the task of developing a method aimed at carrying out postoperative immobilization of the scrotum during orchiopexy for cryptorchidism using a fixation device.

When implementing the claimed method, a technical result is achieved, which consists in improving the course of the postoperative period during orchiopexy for cryptorchidism.

The specified technical result in the implementation of the invention is achieved in that the method of surgical treatment of cryptorchidism with immobilization of the scrotum after orchidopexy in children is characterized by the fact that a device is applied to the scrotum, represented by slots for an elastic band located on a plastic case, the medial surface of which has the shape of a bowl with perforations, containing transitions to the wings located laterally, while the specified is fixed in such a way that the perforated part of the inner surface of the housing bowl covers the scrotum, and the lateral wings fit snugly against the medial surfaces of the lower extremities and are fixed by means of an elastic band enveloping the lower extremities, thereby securing the device below waist of the patient and, accordingly, blocking the displacement of the skin of the inner surface of the thigh relative to the scrotum.

The method uses a device represented by slots 4 for elastic tape 6 located on a plastic case 1, the medial surface of which has the shape of a bowl 5 with perforations 2, containing transitions 7 into wings 3 located laterally.

In FIG. 1 is a top view of the device without elastic band 6.

In FIG. 2 is a side view of the device.

In FIG. 3 shows a view from the side of the inner surface of the bowl 5 with perforations 2.

In FIG. 4 shows a front view of the device.

In FIG. 5 shows a method of attaching the device to the patient's body by means of an elastic band 6 according to the method.

The method is carried out as follows.

Under endotracheal anesthesia, after processing the surgical field, an incision is made under the navel, through which a trocar with a diameter of 3 mm is inserted. Carbon dioxide is insufflated into the abdominal cavity through the trocar at a pressure of 5-7 millimeters of mercury. The first step is to perform an audit of the abdominal organs with a close examination of the inguinal regions. Pay attention to the condition of the internal inguinal rings on both sides, including the healthy one, if the cryptorchidism is unilateral. An undescended testicle is visualized, which can be located both in the abdominal cavity and in the inguinal canal. If it turns out that the testicle is located high in the abdominal cavity, two additional 3 mm trocars are placed in the right and left iliac regions. Before closing the internal inguinal ring (the extraperitoneal LASSO method is used), the testis is mobilized while maintaining the peritoneal bridge at the location of the spermatic cord and its vessels. The internal testicular vein and artery are crossed only if, by stretching, they cause an obstacle to adequate reduction of the testicle into the scrotum. If the testicle is “hiding” (freely enters and exits the inguinal canal) or has an inguinal location, its mobilization is not required. The internal inguinal ring is closed extraperitoneally. In the presence of a non-obliterated inguinal ring from the side where the testicle is located in the scrotum, in order to prevent the formation of a direct inguinal hernia, it is also closed. If the undescended testicle is located in the inguinal canal, but a closed internal inguinal ring is visible during laparoscopy, the laparoscopic stage of the operation is completed.

The second stage of the operation is the reduction and fixation of the testicle. To do this, perform an incision in the skin of the scrotum. Form the future bed for the testicle. In the direction of the outer inguinal ring, spreading the tissues, they search for and detect an undescended testicle. Assess its size and condition. The vaginal process of the peritoneum is crossed with the preservation of blood vessels and the spermatic cord. During isolation, the walls of the vaginal process are preserved, their suturing is not required, since the internal inguinal ring is already closed and there is no prerequisite for the formation of an inguinal hernia, which significantly reduces the time of the operation. After that, the degree of tension of the spermatic cord and its vessels is assessed when the testicle is located in the scrotum.

With a pronounced tension of the elements of the vas deferens, the testicle is stitched through the albuginea. The ligature is passed through the skin of the scrotum and fixed to the skin of the thigh. When performing orchidopexy without a pronounced tension of the elements of the vas deferens, the testicle is fixed in the scrotum according to the Petrivalsky method.

To limit injury and securely fix the scrotum in a static position, a device is placed on the patient's scrotum in such a way that the perforated part 2 of the inner surface of the bowl 5 of the body 1 covers the scrotum, and the lateral wings 3 fit snugly against the medial surfaces of the lower extremities (transition 7 allows for protection external seam on the inner surface of the thigh (with a pronounced tension, since it does not delimit the scrotum itself from this area) and is fixed by means of an elastic band 6 that wraps around the lower limbs, thereby securing the device below the patient's waist and, accordingly, blocking the displacement of the skin of the inner surface of the thigh relative to scrotum.

After three days, the device is removed from the patient, the interrupted suture is removed, fixing the testicle and scrotum to the thigh (if any). By this time, the descended testicle is securely fixed, which minimizes the possibility of its retraction into the inguinal canal.

The positive effect of the claimed invention consists in ease of use, in improving the course of the postoperative period during orchiopexy for cryptorchidism, due to the reliable immobilization of the scrotum to the lower extremities of the patient due to the snug fit of the wing 3 with the transition 7 to the site of the interrupted suture (or without it) and fixation devices on the patient's body with an elastic band 6, which reduces skin tension in this anatomical region and accelerates healing.

The invention can be used in the field of pediatric surgery to perform postoperative immobilization of the scrotum during orchiopexy for cryptorchidism.

The description of the method is supplemented with examples:

Example 1

Patient E., 9 months old. Diagnosis: Right-sided cryptorchidism, inguinal form of testicular retention (hidden). Diagnostic laparoscopy was performed. It was revealed that the right and left inguinal canals are open. The right testicle is located at the internal inguinal canal and moves freely both into the abdominal cavity and into the inguinal canal. Intraperitoneal suturing of the internal inguinal rings was performed according to the LASSO method, the right testicle was first brought down into the right inguinal canal. An incision was made in the right half of the scrotum. The right testicle was found, which has dimensions of 1.5 × 1.0 cm. The testicle was isolated from the surrounding tissues. The vaginal process is crossed, the elements of the spermatic cord are highlighted. Mobilized place for the testicle. After bringing down the right testicle into the scrotum, it was revealed that there is a significant tension of the seminal duct and its vessels. It was decided, in addition to fixation according to Petrivalsky, to additionally stabilize its normal position and prevent possible retraction of the testicle to the inguinal canal, to fix it to the inner surface of the right thigh. After that, the skin of the scrotum was sutured. To provide rest to the descended testicle and protect the suture that fixes the scrotum to the inner surface of the thigh, the developed device is placed on the patient according to the described method, with the wing 3 adjacent to the medial surface of the lower limb so that the transition 7 covers the ligature zone, without delimiting the scrotum itself from this areas. Treatment of seams with antiseptic solutions is carried out daily. After three days, the device was removed and the interrupted suture was removed, fixing the testicle and scrotum to the thigh. The postoperative period proceeded without complications. The patient was examined 1, 3 and 6 months after the operation - the testicle is located in the scrotum.

Example 2

Patient M., 13 months old. Diagnosis: Left-sided cryptorchidism, inguinal form of testicular retention. Laparoscopy revealed that the right and left inguinal canals are closed. There is no left testicle in the abdominal cavity, the elements of the spermatic cord go into the inguinal canal. Laparoscopy completed. A transverse scrototomy was performed on the left, the testicle was isolated, the vaginal process of the peritoneum was transected, the testicle was fixed in the scrotum according to Petrivalsky. The skin on the scrotum is sutured.

For the protection of the postoperative wound, a device is applied to the patient, according to the method being implemented, which achieves immobilization of the scrotum relative to the lower extremities (due to the design of the body and the location of elastic bands around the hips, which secures the device below the patient's waist and, accordingly, blocks the displacement of the skin at the site of application seams). At the end of three days, the device was removed, there were no complications from the wound. Postoperative period without pathologies.

Claims (1)

A method for immobilizing the scrotum after orchidopexy in children, characterized in that a device with slots for an elastic band located on a plastic case is applied to the scrotum, the medial surface of which has the shape of a bowl with perforations, containing transitions to wings located laterally, while the device is fixed in such a way that the perforated part of the inner surface of the body bowl covers the scrotum, and the lateral wings are adjacent to the medial surfaces of the lower extremities and are fixed by means of an elastic band that wraps around the lower extremities, after 3 days the device is removed.

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