RU2281700C2 - Modified method for plasty of posterior wall of inguinal canal at inguinal hernias - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: one should take aside a spermatic funiculus laterally, perform cross-sectional incisions at aponeurosis of rectus muscle of abdomen at length being correspondent to that of the defect of posterior wall, continue these incisions onto lateral and posterior-lateral parts of aponeurosis of rectus muscle up to the site of aponeurosis ending to connect these incisions behind rectus muscle longitudinally, invert the edge of mobilized fragment into inguinal space to suture the fragment into medial part of inguinal space and suture the fragment with iliopubic cord. Then, layer-by-layer one should suture in cross-sectional, internal oblique muscle towards the lower edge of Poupart's ligament at developing an internal inguinal ring. The innovation enables to exclude the development of aponeurotic defect at anterior surface of the rectus muscle of abdomen and decrease the risk of relapses.

EFFECT: highr efficiency.

1 dwg, 1 ex

Description

The invention relates to medicine, namely to abdominal surgery.

In abdominal surgery, there are more than 200 different methods of hernioplasty for inguinal hernias described in the monographs of N.I. Kukudzhanov, V.I. Orekhovsky and in periodicals.

Among the autoplastic techniques for strengthening the posterior wall of the inguinal canal, methods of Kukudzhanov, Lotheissen - McYay, Orekhovsky V.I. are used to cover the high inguinal gaps.

A disadvantage of the described hernioplasty in secondary forms of oblique and direct hernias, where mobilized aponeurosis of the rectus abdominis by means of its longitudinal dissection or incisions, is the formation of herniform defects on the anterior surface of the rectus abdominis muscle, especially in elderly patients with hapo - and atrophy of this muscle.

As a prototype, the method of V.V. Orekhovsky was used, described in the monograph "Basic herniotomy." Donetsk, 2000. In this paper, a method is described for cutting out a square-shaped aponeurosis flap of the anterior wall of the rectus abdominis muscle and moving it to the posterior wall of the inguinal canal.

The aim of the invention is to develop a more effective method of plastic surgery of the posterior wall of the inguinal canal.

The essence of the invention.

Possibility of non-tension plastic surgery of the posterior wall of the inguinal canal with average size of inguinal hernias by mobilizing and moving the cut aponeurosis flap of the anterolateral part and the posterior edge of the aponeurosis of the rectus abdominis muscle into the medial part of the inguinal gap.

The claimed method of plasty of the posterior wall of the inguinal canal with inguinal hernias involves the removal of the hernial sac, mobilization of the spermatic cord, the formation of a flap from the aponeurosis of the anterior wall of the rectus muscle, moving it to the posterior wall of the inguinal canal.

New tricks are the following:

- divert the spermatic cord laterally,

- transverse incisions are made on the aponeurosis of the rectus abdominis muscle according to the length of the defect of the posterior wall,

- then continue these cuts on the lateral and posterolateral parts of the aponeurosis of the rectus muscle to the place where the aponeurosis ends,

- then connect these incisions behind the rectus muscle longitudinally, turn the edge of the mobilized flap into the inguinal gap,

- sew a flap into the medial part of the inguinal space, sew with an iliac-pubic cord,

- sutured in layers the transverse internal oblique muscle to the lower edge of the pupartic ligament with the formation of the internal inguinal ring (drawing).

The claimed method allows to exclude the formation of an aponeurotic defect on the front surface of the rectus abdominis muscle, to reduce the recurrence rate, i.e. increase the effectiveness of treatment.

Clinical example

Patient Magomedov A.M. operated on for strangulated inguinal hernia 1 hour after receipt. During herniotomy, it was diagnosed that the hernia is straight with a triangular inguinal gap. The restrained viable loop of the small intestine is set into the abdominal cavity. The inguinal gap had dimensions: length - 5.5 cm; a height of 4 cm. Given the destruction of the posterior wall of the inguinal space (transverse fascia) and the height of the inguinal space, a flap of the aponeurosis of the rectus muscle from the anterolateral and posterolateral part is cut and mobilized with two cuts. The cut flap is sewn without tension to the iliac-pubic cord, thereby strengthening the back wall. Subsequent plastics were produced according to the type of plastics of the posterior wall of Shuldais. After laying the seminal carriage, the aponeurosis of the external oblique muscle of the abdomen was restored to its place.

Distinctive features of the prototype.

A distinctive feature of modified hernioplasty is that for the first time, the movement of the aponeurosis of the rectus muscle into the medial part of the inguinal gap is used without the formation of an aponeurotic defect on the front surface of the rectus abdominis muscle.

The positive effect of the invention

The invented technique allows to improve the results of treatment of inguinal hernias, especially in patients with complicated hernias (recurrent, strangulated, oblique hernias with a straightened inguinal canal) with average sizes of the inguinal gap. The main indicator of improving the results of surgical treatment of inguinal hernias is the relapse rate. As a result of a differentiated approach to the treatment of various forms of inguinal hernias, the introduction and use of this method since 2000, we managed to reduce the frequency of recurrence of inguinal hernias by 5 times.

Claims (1)

The method of plasty of the posterior wall of the inguinal canal with inguinal hernias, including the removal of the hernial sac, mobilization of the spermatic cord, the formation of a flap from the aponeurosis of the anterior wall of the rectus muscle, moving it to the posterior wall of the inguinal canal, characterized in that the spermatic cord is laterally removed, transverse incisions are made into aponeurosis of the rectus abdominis muscle with a length corresponding to the length of the defect of the posterior wall, then these cuts continue to the lateral and posterolateral parts of the aponeurosis of the rectus muscle to the place where aponeurosis occurs, then these sections are joined longitudinally behind the rectus muscle, the edge of the mobilized flap is turned out in the inguinal space, the flap is sewn into the medial part of the inguinal space, sutured with the iliac-pubic cord, the transverse internal oblique muscle is sutured in layers to the lower edge of the pupartic ligament with the formation of rings.