UA74462U - Method for surgical treatment of inguinal hernia - Google Patents

Abstract

A method for the surgical treatment of the inguinal hernia relates to the general surgery and can be used in low invasive technologies.

Description

The useful model belongs to medicine, namely, to general surgery, and can be used in the treatment of inguinal hernias using minimally invasive technologies.

There is a known method of extraperitoneal endoscopic hernioplasty, according to which, under endotracheal anesthesia, an incision is made in the skin and subcutaneous tissue up to 2.0-2.5 cm below the navel. The aponeurosis is singled out and dissected in the transverse direction for 2.0-2.5 cm. A balloon device is introduced into the preperitoneal space in the direction of the frontal bone and the parietal peritoneum is separated from the anterior abdominal wall by air injection.

After removing the balloon device, a trocar with a diameter of 12 mm with a laparoscope is introduced into the incision. The created cavity is supported by retrocarboxyperitoneum under a pressure of 8 mm Hg. Art. Two working trocars (5 mm and 12 mm) are introduced into the space, with the help of which the hernia sac is released. The pubic bone, inguinal ligament, elements of the spermatic cord, ligament are exposed

Kupper and lower epigastric vessels. A non-fixing polypropylene mesh (10 x 15 cm in size) is inserted into the pre-abdominal space. Placement of the prosthesis is carried out in such a way that it covers the formation zones of direct and oblique hernias. Trocars are removed. 1-2 sutures are placed on the wound below the navel (Reglii 5.5., Mazzaa A. Airbegi R. // 9. | aragoepdozs. Zyga. - 1992. - Moi. 2, M 6. - R. 281-286...

The specified method does not sufficiently ensure the efficiency and reliability of the operation, especially with large sizes of the internal inguinal ring, migration of the mesh, seroma formation, and an increase in the number of recurrences are possible.

The useful model is based on the task of increasing the efficiency and reliability of the operation, preventing mesh migration, and reducing the risk of postoperative complications and recurrences.

The task is solved by the fact that in the method of surgical treatment of inguinal hernias in adults, which includes endoscopic formation of the cavity, selection of the hernia sac and placement of a mesh implant in the extraperitoneal space in the area of the hernia, according to a useful model, a herniorrhaphy of suturing the deep inguinal ring with absorbable material is performed , with nodal sutures, after that the mesh implant is fixed with a continuous, absorbable suture to the iliopubic cord and Kupper's ligament along the lower contour, and on the upper edge of the hernial defect 2-3 cm above, the mesh implant is fixed with nodal sutures to the transverse fascia and internal oblique muscle.

З The claimed method ensures the efficiency and reliability of the operation, prevents mesh migration, reduces the risk of postoperative complications and recurrences.

A useful model is explained by an example.

Example

Patient V., born in 1940.

Diagnosis: Right-sided direct inguinal hernia.

Complaints of bulging in the inguinal region on the right. The hernial protrusion appeared about 1 year ago after heavy physical exertion, increased in size, pains began to bother me.

Objectively: in the right inguinal region, there is a 5 x 4 cm oval hernial protrusion of a soft-elastic consistency - rectifiable, the symptom of a coughing fit is positive.

Surgical treatment.

Under general anesthesia, a balloon was inserted into the pre-abdominal space above the pubis through a paraumbilical incision. A cavity was formed and trocars were inserted above the pubis and in the right pubic region. Gas was introduced extraperitoneally - pressure 12 mm Hg. Art.

A hernial sac was identified. Straight hernia. Mobilized fascial-aponeurotic edges of the hernial gate on the right. Internal inguinal ring up to 4 cm. Herniorrhaphy was performed. A 15 x 10 cm prolene mesh was introduced and straightened in the projection of the hernial gate. The mesh is fixed with a Mo 2 vicryl suture to the ilio-pubic cord and Kupper's ligament along the lower contour. Along the upper edge of the hernial defect, 2-3 cm higher, the mesh is fixed with knotted vicryl sutures to the transverse fascia of the internal oblique muscle. Gas has been removed from the pre-abdominal space.

Wounds are sutured in layers. There was no recurrence of the hernia.

According to the proposed method, three patients were treated without recurrence.

Claims (1)

USEFUL MODEL FORMULA The method of surgical treatment of inguinal hernias in adults, which includes endoscopic formation of the cavity, selection of the hernial sac and placement of a mesh implant in the extraperitoneal space in the area of the hernia, which is characterized by performing herniorrhaphy of suturing the deep inguinal ring with a material that dissolves, knotted sutures, after that fixation of the mesh implant with a continuous suture, which 60 is resorbed, to the iliopubic cord and Kupper's ligament along the lower contour, and on the upper edge of the hernial defect 2-3 cm above, the mesh implant is fixed with knotted sutures to the transverse fascia and internal oblique muscle.