RU2086189C1 - Method for treating inguinal hernia in children - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out laparoscopic access, gripping hernial sack top from inside, performing its traction through hernial gates until the hernial sack is fully turned inside out into the abdominal cavity. Then the hernial sack top is fixed on the anterior abdominal wall. EFFECT: enhanced effectiveness of operation.

Description

 The invention relates to medicine, namely to surgery, and can be used in herniology.

 A known method of surgical treatment of inguinal hernias in children, including an oblique incision in the inguinal region along the inguinal canal to the aponeurosis of the external oblique muscle, the allocation of "legs" of aponeurosis, forming the external inguinal ring. Of the elements of the spermatic cord, a hernial sac is isolated, which is mobilized to the inner inguinal ring. The hernial sac at the level of the internal inguinal ring is stitched, bandaged and cut off. The aponeurosis of the external oblique muscle is tightened with 2-3 sutures (S. N. Doletsky, A.B. Okulov "Inguinal hernias in children", Surgery, N 10 1978 p. 55-63).

 The method is accompanied by early and late postoperative complications associated with impaired blood flow in the testis on the side of the operation, as well as impaired crematoric muscle function.

 A known method of treating inguinal hernias in children, in which laparoscopy is performed according to a standard technique, is carried out using a special manipulator under the control of a laparoscope in a hernial sac through a catheter through the inner inguinal ring and cyanocryal glue is insufflated along the catheter. After removing the catheter and pressing the outside of the tissue in the projection of the inguinal canal, obliteration of the hernial sac occurs. (V.N. Stelmakovich, L.P. Milyukova, Laparoscopy in the treatment of inguinal hernias in children. Abstracts of the symposium "Actual issues of laparoscopy in pediatrics" p. 55, M.1994.).

 The method is less traumatic and improves the results of treatment of inguinal hernias in children.

 However, the method has several disadvantages.

 Firstly, the introduction of a foreign substance into the hernial sac is undesirable, and secondly, due to the lack of visual control over the obliteration of the hernial sac, formation of residual cavities is possible, which can lead to the formation of spermatic cord cysts.

 The objective of the invention is to provide a method for the treatment of inguinal hernias in children, ensuring the complete elimination of hernial protrusion and reduction of postoperative complications.

 The problem is solved in that in the method of treating inguinal hernias in children, including laparoscopic access, according to the invention, the top of the hernia sac is captured from the inside, it is traction through the hernia gate until the hernia sac is completely inverted into the abdominal cavity, then the top of the hernia sac is fixed to the anterior abdominal wall .

 Turning the hernia sac into the abdominal cavity through the hernia gate and fixing the top of the hernia sac to the anterior abdominal wall ensures the complete elimination of hernial protrusion under the control of the laparoscope, without the need for the introduction of adhesives. All this reduces postoperative complications.

 The method is carried out, for example, as follows.

 Laparocentesis is performed at the lower umbilical point with a trocar with a diameter of 5 mm and laparoscopic diagnosis of hernial protrusion is performed. After confirming the diagnosis, the size of the hernial sac is determined.

 Having departed from the projection of the hernial collar onto the anterior abdominal wall to a distance corresponding to the length of the hernial sac, a manipulation trocar with a diameter of 5 mm is introduced in the inguinal region on the anterior abdominal wall, through which a laparoscopic clip is inserted. The clamp through the hernia gate is introduced into the hernial sac and capture the top of the hernial sac. Traction is carried out for the top of the hernia sac through the hernia gate until the hernia sac is completely inverted into the abdominal cavity. The tip of the hernia sac is removed using a laparoscopic clamp to the wound on the anterior abdominal wall remaining from the manipulation trocar and fixed with a nodal suture to the aponeurosis of the anterior abdominal wall. After a checkup, the wounds are sutured.

 The method is illustrated by the following clinical example.

 Patient Zhenya O., 3 years old, after sedation and mask anesthesia in the lower umbilical point along the midline of the abdomen introduced a trocar with a diameter of 5 mm and after creating the pneumoperitoneum with the Storz laparoscope, the abdominal cavity was examined. In the right lateral inguinal fossa, hernial gates with a diameter of 1.5 cm and a hernial sac of 4x3 cm were found.

 In the right inguinal region, deviating from the projection of the hernia gate to the anterior abdominal wall of 3 cm, a manipulation trocar with a diameter of 5 mm was introduced into the abdominal cavity under the control of a laparoscope. A laparoscopic clamp is installed in the trocar; under the control of the laparoscope, the clamp is inserted through the hernia gate into the hernial sac. The top of the bag is captured by a laparoscopic clamp and, by traction through the hernia gate, the hernial bag is “turned” into the abdominal cavity. Then, without releasing the top of the bag from the grip, the laparoscopic clamp was removed along with the trocar from the abdominal cavity, while the tip of the hernial sac was removed into the wound and fixed to the aponeurosis of the anterior abdominal wall with a nodal suture. After a control examination, the complete elimination of hernial protrusion was confirmed. Dysfunction produced. The wounds are sutured. The duration of the operation is 15 minutes The duration of anesthesia is 20 minutes. The child was discharged from the hospital 10 hours after the operation. Sutures were removed after 7 days. The wounds healed by primary intention. At a local examination, there are no signs of hernial protrusion.

 The proposed method performed 25 operations for patients aged 3 to 10 years. Monitoring of patients for four months did not reveal complications.

 Using the proposed method allows to completely eliminate the hernial protrusion under the control of a laparoscope. It does not require the use of adhesives that are foreign to the body. The method is less traumatic and reduces postoperative complications.

Claims (1)

 A method of treating inguinal hernias in children by laparoscopic access, characterized in that the apex of the hernial sac is grasped from the inside, traction through the hernial gates until the hernial sac is completely inverted into the abdominal cavity, then the apex of the hernial sac is fixed to the anterior abdominal wall.