RU2445002C2 - Method of treating injuinal and femoral hernias - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to herniology. Method is realised by closing hernial orifice with mesh from biologically and chemically inert material, made with projection at medial edge. Size of projection at medial edge of mesh corresponds to distance from medial edge of inguinal ligament at the level of femoral vein to the lower edge of upper-horizontal branch of pubic bone. Edge of protrusion is fixed by means of ligatures to upper-horizontal branch of pubic bone.

EFFECT: method increases reliability of implant fixation.

5 dwg

Description

The invention relates to medicine, is used to close the defect in the abdominal wall in patients with femoral hernia.

There is a method of pre-abdominal elimination of inguinal and femoral hernias by plasty of the posterior wall of the inguinal canal by suturing the tendon parts of the internal oblique and transverse muscles with the U-shaped sutures, the outer edge of the rectus sheath to the scallop ligament and creating a duplicate transverse fascia with interrupted sutures with the restoration of the inguinal canal (1 )

The disadvantages of the method are the complexity of the operation due to the use of technology for stitching tissues with tension during plastic inguinal and femoral canal.

A known method of closing a hernia gate according to Liechtenstein. In this case, the inguinal canal is opened, hernia repair is performed, and the hernial gate is closed using an elastic wall made of non-absorbable material, the lower edge of which is fixed to the pupartic ligament, and the upper edge to the front surface of the internal oblique muscle of the abdomen. The operation is used in the treatment of direct and oblique inguinal hernias (2, 3).

The disadvantage of this method is the low effectiveness of treatment with combined inguinal and femoral hernias.

There is also a method of treating inguinal and femoral hernias, comprising closing the hernial portal with an elastic mesh of non-absorbable polymeric material by fixing its lower edge to the pupartic ligament and the upper edge to the front surface of the internal oblique muscle of the abdomen, the mesh having an opening for the spermatic cord and a cut through it . The mesh is made with a protrusion covering the lacuna of the lymphatic gland. The mesh is fixed with the lower edge to the scallop fascia and superficial fibers of the scallop muscle, its upper medial edge is fixed to the vagina of the rectus abdominis muscle, the mesh is additionally fixed over the entire surface to the front surface of the transverse fascia of the abdomen (4).

The disadvantage of this method is the inability to fix the polymer material to close the lacunae of the lymphatic gland with destroyed scallop fascia and periosteum of the pubic bone.

The aim of the invention is to improve the results of surgical treatment of patients with femoral and inguinal hernias.

This goal is achieved by the fact that the size of the protrusion at the medial edge of the mesh corresponds to the distance from the medial edge of the pupartic ligament at the level of the femoral vein to the lower edge of the superior horizontal branch of the pubic bone, while the lower edge of the protrusion is fixed using ligatures to the upper horizontal branch of the pubic bone.

Comparison of the proposed method with other known in the field of medicine showed its compliance with the criteria of the invention.

The method is illustrated in graphic material.

Figure 1 shows the initial moment of operation; figure 2 shows the preparation for closing the hernia gate; figure 3 shows the fixation of the implant; figure 4 shows the key point of the operation - fixing the protrusion at the medial edge of the mesh to the upper horizontal branch of the pubic bone with three ligatures of non-absorbable synthetic material; figure 5 shows the implant.

The method is implemented as follows.

The approach to the femoral hernia is through inguinal access. For this, a cut from 8 to 12 cm long dissects the skin, subcutaneous tissue, superficial fascia. The aponeurosis of the external oblique muscle of the abdomen in the area of the external opening of the inguinal canal is distinguished and exposed with a restrained femoral hernia - a hernial sac, and with a correctable femoral hernia - the external opening of the femoral canal below theparticular ligament. After the audit, the hernial sac is mobilized to the neck, which goes under the pupartic ligament. The front wall of the inguinal canal is opened. The spermatic cord or round ligament of the uterus is shifted up; the superficial fascia is dissected above the neck of the hernial sac and the neck of the hernial sac is bypassed by the dissector. With a small size of the hernial sac, the hernial sac along with the contents is transferred to the inguinal canal. With a restrained hernia, the hernia sac is opened from the femoral canal, the contents of the hernia sac are evaluated. If the omentum is infringed, it is resected so as to reduce the size of the hernial protrusion and to ensure the transfer of the hernial sac from the femoral to the inguinal canal. The contents of the hernial sac are processed, evaluated and inserted into the abdominal cavity, or a resected organ is resected. The hernial sac is sutured at the level of the deep femoral ring and the stump of the hernial sac is moved to the preperitoneal space. An implant of the aforementioned form is cut out, which is positioned so that an additional protrusion is located between the femoral vein, partartic ligament, pubic tubercle, and along the lower contour below the upper horizontal branch of the pubic bone. The implant is fixed in the projection of the femoral canal by suturing it to the pubis with three ligatures of non-absorbable synthetic material, which are carried out around the implant and the upper horizontal branch of the pubis. At the level of the femoral canal, the implant is sutured to the pupartic ligament along the length of the inguinal canal. After modeling the holes in the implant, a spermatic cord is passed through it. The dissected portion of the implant is sutured with a continuous non-absorbable thread. Along the upper contour, the implant is hemmed from the inside to the aponeurosis of the external oblique muscle of the abdomen, medially to the pubic tubercle. The edges of the aponeurosis (the front wall of the inguinal canal) are sutured above the implant to the spermatic cord, which is located in the projection of the deep inguinal ring. In the subcutaneous tissue, polyvinyl chloride drainage is established, after which the edges of the skin are sutured. The drain is connected to a vacuum aspirator.

Using the proposed method can improve the reliability of fixation of the implant, which increases the reliability and effectiveness of treatment.

The method is possible and advisable to use for the treatment of patients with femoral and inguinal hernias, mainly with long periods of hernia, in which it is impossible to fix the implant in other ways.

Information sources

1. Klebanov A.N., Rybakov M.S., Ostroukhov N.F. The simultaneous elimination of bilateral inguinal and femoral hernias. Surgery. 1998, No. 4, S.51-52.

2. Egiev V.N., Chizhov D.V., Rudakova M.N. Plastic surgery according to Liechtenstein for inguinal hernias. Surgery. 2000, No. 1, S.19-21.

3. Lichtenstein I.L., Shulman A.G., Amid P.K. The tension-free hemioplasty. Am. J. Surg., 1989; 157: 188-193.

4. RF patent No. 2257159 M. Cl. A61B 17/00, 2005

Claims (1)

A method of treating femoral and inguinal hernias, comprising closing the hernial portal with an elastic mesh of biologically and chemically inert material and fixing it, made with a protrusion at the medial edge to close the lymph gaps of the lymph gland, characterized in that the size of the protrusion at the medial edge of the mesh corresponds to the distance from the medial edge pupartic ligament at the level of the femoral vein to the lower edge of the superior horizontal branch of the pubic bone, while the lower edge of the protrusion is fixed using ligatures to the superior horizontal branch of the pubis no bone.

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