RU2840695C1 - Minimally invasive method of treating small umbilical hernia under ultrasound navigation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery. Ultrasonic examination of umbilical hernia is carried out and absence of content in hernial sac is specified. Traction is performed for centre of navel skin and hernial sac is set. After local anaesthesia in area of navel is performed in aseptic environment, two symmetric skin punctures by 2 mm on the right and left paraumbilically are performed with a sharp-pointed scalpel. Under visual and ultrasonic control hydraulic preparation of tissues is carried out by injection of local anaesthetic in direction of needle insertion to preperitoneal space. Ligatured needle is inserted through the punctures. Ligature is drawn around the hernia defect. When using the arched cutting needle with the non-absorbable ligature pre-filled therein, the needle is inserted through the puncture to the right of the navel under visual and ultrasonic control. Arc-shaped cutting needle with a ligature is delivered through a musculo-aponeurotic layer into preperitoneal subcutaneous fat. Needle with ligature is carried out through preperitoneal fat to opposite side of navel cranially from hernia defect, and then again through the musculo-aponeurotic layer from the inside out and brought out from the opposite side of the navel through the skin puncture in the paraumbilical region on the left. Needle is again filled with a ligature, leaving through the puncture in the paraumbilical region on the right, and then, under visual and ultrasonic control, the needle manipulation is repeated, passing the arc-shaped cutting needle with a ligature through the puncture in the paraumbilical region to the right to the opposite side of the navel caudally from the hernia defect. When using the single needle with a filament, after the needle is brought through the musculo-aponeurotic layer inside-out and brought out through the skin puncture in the paraumbilical region on the left, the needle is brought in the caudal direction in relation to the navel – towards the right prick-in. Ligature is tied with closure of hernia defect at level of aponeurosis by means of self-tightening knot. Ends of the ligature are cut off, and the knot is immersed under the skin, and the skin punctures are treated with an antiseptic.

EFFECT: method enables eliminating the aponeurosis defect by a minimally invasive method under local anaesthesia.

1 cl, 5 dwg

Description

The invention relates to medicine, namely to surgical methods for treating small umbilical hernias.

The closest in technical essence is the method of herniotomy for umbilical hernia in children [Svarich V.G., Islentyev R.N., Lisitsyn D.A., Perevozchikov E.G. 2017. Patent No. 2 636 874]. The essence of the method is as follows. Through a puncture under the navel, under visual and palpatory control, a spinal needle with a non-absorbable ligature previously inserted into it is inserted tangentially to the hernial sac strictly at the point where its vertical part transitions to the horizontal and the needle is punctured through a puncture in the skin above the navel. The needle is removed, after which a needle without a ligature is inserted in a similar way from the opposite side and a ligature previously inserted from the other side is inserted into its distal end and brought out through the proximal end to the outside. The spinal needle is removed and the ligature around the hernial sac is tied with complete closure of the hernial sac at the level of the aponeurosis.

This method has a number of disadvantages:

- the need for combined endotracheal anesthesia,

- does not allow full visualization of the punctured tissues and carries the risk of damage to the abdominal organs,

- the described method was used only in pediatric practice.

The aim of the invention is to improve the results of surgical treatment of small umbilical hernias.

We achieve the set goal by eliminating the aponeurosis defect in umbilical hernia without cutting soft tissues and cutting off the navel, by passing a non-absorbable thread around the hernial defect using a needle under ultrasound control.

The method is carried out as follows.

After performing an ultrasound examination of the umbilical hernia and confirming the absence of contents in the hernial sac, local anesthesia is administered paraumbilically under aseptic conditions. Then the hernial sac is reduced (traction by the center of the umbilical skin and pulling the hernial sac inward). Two symmetrical punctures of 2 mm each are made paraumbilically on the right and left with a pointed scalpel. Under visual and ultrasound control, local anesthetic is injected along the needle insertion path deep into the preperitoneal space with hydraulic tissue preparation. A 3/8 arc-shaped cutting needle with a non-absorbable ligature pre-threaded into it is inserted through a puncture to the right of the navel under visual and ultrasound control, passed through the muscular-aponeurotic layer into the preperitoneal tissue, passed under the aponeurosis to the contralateral side of the navel cranial to the hernial defect, again passed through the muscular-aponeurotic layer from the inside out and brought out from the contralateral side of the navel through a skin puncture to the left. The needle is removed, a thread is passed. The needle is again threaded with a ligature, which comes out through a skin puncture to the right of the navel. Then the manipulation with the needle is repeated by passing it through a skin puncture to the right of the navel under visual and ultrasound control, now caudal to the hernial defect. The needle with the thread is poked out through a skin puncture to the left of the navel. The ligature, thus encircled around the hernial defect, is tied with its closure at the level of the aponeurosis using a self-tightening knot, with subsequent cutting of the ends of the ligature and immersion of the knot under the skin. In the case of using a single needle with a thread, the method is carried out in a similar way with the only difference that the needle is inserted in the caudal direction relative to the navel in the direction opposite to the cranial insertion of the needle - towards the puncture. Skin punctures are treated with an antiseptic and do not require additional suturing.

Brief description of the drawings :

Fig. 1. Anterior abdominal wall. Injection of anesthetic with saline solution into the preperitoneal space.

Fig. 2. Anterior abdominal wall. Insertion of an arcuate needle through the aponeurosis into the preperitoneal space.

Fig. 3. Anterior abdominal wall. Insertion of the needle through the preperitoneal space, aponeurosis with a puncture on the opposite side from the navel.

Fig. 4. The first passage of the needle with thread above the navel.

Fig. 5. Passing the needle with the thread under the navel in the opposite direction with a puncture at the point of the first puncture.

This method was used in 15 patients during the section.

Significant differences in the proposed method of herniotomy for umbilical hernia :

- Ultrasound navigation and visualization of structures;

- simplicity of technical execution;

- safety of the procedure;

- performed under local anesthesia;

- reduction of the time required to perform surgical intervention;

- no tissue dissection, no opening of the abdominal cavity;

- preservation of the anatomical structure of the navel area;

- no need to suture the postoperative wound;

- possibility of application in adult practice.

Claims (1)

A method of herniotomy for a small umbilical hernia, characterized by the fact that after performing an ultrasound examination of the umbilical hernia and clarifying the absence of contents in the hernial sac, traction is performed on the center of the skin of the navel and the hernial sac is reduced, two symmetrical punctures of the skin in the navel area are made with a pointed scalpel, then a needle with a ligature is inserted through the punctures, the ligature is drawn around the hernial defect, the ligature is tied with the closure of the hernial defect at the level of the aponeurosis using a self-tightening knot, the ends of the ligature are cut off and the knot is immersed under the skin, the skin punctures are treated with an antiseptic, characterized in that after performing local anesthesia in the navel area under aseptic conditions, two symmetrical punctures of 2 mm each of the skin are made with a pointed scalpel on the right and left paraumbilically, under visual and ultrasound control, hydraulic tissue preparation is performed by pumping local anesthetic along the needle insertion path to the preperitoneal space, and when using an arc-shaped cutting needle with a non-absorbable ligature pre-inserted into it, the needle is inserted through a puncture to the right of the navel under visual and ultrasound control, the arc-shaped cutting needle with the ligature is passed through the muscular-aponeurotic layer into the preperitoneal tissue, then the needle with the ligature is passed through the preperitoneal tissue to the opposite side of the navel cranial to the hernial defect, and then again through the muscular-aponeurotic layer from the inside out and brought out from the opposite side of the navel through a puncture of the skin in the paraumbilical region on the left; then the needle is again threaded with a ligature coming out through a puncture in the paraumbilical region on the right, and then, under visual and ultrasound control, the manipulation with the needle is repeated, passing an arc-shaped cutting needle with a ligature through a puncture in the paraumbilical region on the right to the opposite side of the navel caudally from the hernial defect, and when using a single needle with a thread, after passing the needle through the muscular-aponeurotic layer from the inside out and bringing it out through a puncture of the skin in the paraumbilical region on the left, the needle is passed in a direction caudal to the navel - towards the right puncture.