sliding hernia repair

When the part of the inguinal hernia is composed of the abdominal internal organs, it is a slippery. Although the incidence is low, if it is not handled properly, it often damages the internal organs or causes recurrence. At the time of surgery, in addition to the surgical procedure for the general inguinal hernia repair, the viscera must be returned to the abdominal cavity. Commonly used repair methods for the inguinal hernia are intraperitoneal and transabdominal. Abdominal spasm repair (Bevan) This method is suitable for general slippery, and the length of the intestine is more than 5cm, but not more than 10cm. For the slippery sputum with a longer intestinal fistula more than 10cm, repairing with this method will cause bowel flexion and obstruction or affect blood supply. It should be repaired by abdominal cavity method. LaRoque-Moschcowitz This method is suitable for slipping off the gut of more than 10cm. Mostly used on the left side. Extramedullary sacral repair (Zimmerman) With the advancement of inguinal hernia repair, the importance of using the transverse fascia and repairing the inner ring is receiving increasing attention. The principle of high ligation of the sac is not overemphasized. This new perspective has been quickly applied by many scholars to the repair of the slippery. Zimmerman et al. proposed a simple technique to repair the slipper in 1967. The two methods are much simpler than LaRoque and Bevan, and have received quite satisfactory results. Treatment of diseases: inguinal hernia Indication When the part of the inguinal hernia is composed of the abdominal internal organs, it is a slippery. Although the incidence is low, if it is not handled properly, it often damages the internal organs or causes recurrence. At the time of surgery, in addition to the surgical procedure for the general inguinal hernia repair, the viscera must be returned to the abdominal cavity. Commonly used repair methods for the inguinal hernia are intraperitoneal and transabdominal. Abdominal spasm repair (Bevan) This method is suitable for general slippery, and the length of the intestines is more than 5cm, but not more than 10cm. For the slippery sputum with a longer intestinal fistula more than 10cm, repairing with this method will cause bowel flexion and obstruction or affect blood supply. It should be repaired by abdominal cavity method. Transperitoneal repair (LaRoque-Moschcowitz) This method is suitable for slipping off the intestines over 10cm. Mostly used on the left side. Contraindications Older, combined with severe heart, liver, kidney and other diseases and difficult to tolerate surgery. Preoperative preparation 1. Pay attention to appease the patient's psychology. 2. Pay attention to prevent infection. Surgical procedure Abdominal spasm repair (Bevan) 1. Exposure, incision: The skin incision is the same as "general inguinal hernia repair". Since the detached organ forms the posterior wall of the sac, the anterior side of the sac is the peritoneal reflex of the organ. After longitudinally cutting the anterior wall of the hernia sac, if the contents of the sputum and the posterior wall of the sac are formed by the colon (or other internal organs), the sputum can be diagnosed. 2. Cut the peritoneum on both sides of the colon: separate the spermatic cord from the hernia sac and pull it apart. Spread the wall of the sac, and send the contents of the sputum back to the abdominal cavity through the neck of the sac, to see the colon that constitutes the posterior wall of the sac. Then, use a few hemostats to clamp and lift the peritoneum next to the colon, and cut the peritoneum on both sides and the top of the colon 2 cm from the edge of the colon until the neck of the sac. Lift the colon out of the colon and gently separate it behind the colon to the inner ring. 3. Reconstruction of the mesentery: remove the hemostatic forceps, use the hand-held colon, and suture the peritoneum incision on both sides behind the colon to form a new colonic mesentery, and then suture the remaining incision. 4. High position sutured sac neck: return the colon to the abdominal cavity. In the neck of the sac, the neck is ligated at a high position, and the excess sac is removed. Or the sac in the upper part of the sac is used for three purses, and then ligated from the inside to the outside, and the sac is turned inward. 5. Repair the inguinal canal: suture the transverse fascia defect with the 4th wire, and repair the inguinal canal according to the "surgical subcutaneous subcutaneous displacement of the inguinal hernia repair", and finally suture the subcutaneous tissue and skin. Transperitoneal repair (LaRoque-Moschcowitz) 1. Expose and cut the sac: According to the "general inguinal hernia repair" incision and exposure. After separating and pulling the spermatic cord, extend the incision line of the anterior wall of the sac to the neck of the sac, 1.5 cm away from the wall of the intestine, and carefully separate the surrounding colon, but do not damage the blood vessels. 2. Another peritoneal incision: the extra-abdominal oblique aponeurosis is pulled up as far as possible to fully reveal the intra-abdominal oblique muscle. The intra-abdominal oblique muscle, transverse abdominis muscle and peritoneum were then sliced layer by layer on the lower abdomen. 3. The content of the sputum from the peritoneal incision: After the peritoneum is incision, the operator's finger indicates that the sac is pushed from below, and the thumb and finger of the other hand pull out the contents of the slick. With the two hands in cooperation, the slipped contents (partial sigmoid colon) are returned to the abdominal cavity and raised from the upper incision. 4. Reconstruction of the sigmoid mesenteric membrane: When the sacral sac is completely returned to the abdominal cavity and the abdominal cavity is raised, it can be seen that the direction of both ends of the anterior wall of the sac is shown to be completely upside down. The excess portion of the sigmoid mesentery was excised, and the free edges remaining on both sides were sutured intermittently with a filament. 5. Also to the contents of the sputum: return the sigmoid colon to the abdominal cavity. Under normal circumstances, it is not necessary to fix the peritoneum with the wall layer. 6. Suture the peritoneum and repair the inguinal canal: suture the peritoneum, the transverse abdominis muscle and the intra-abdominal oblique muscle with a medium-sized silk thread, and completely close the incision above the infraorbital nerve. Then repair the abdomen transverse fascia of the inner ring, and repair the inguinal canal, suture the subcutaneous tissue and skin according to the subcutaneous subcutaneous displacement of the inguinal hernia. Abdominal calf repair (Zimmerman) 1. Incision, revealing the inner ring: the same as the general inguinal hernia repair. After the sac was revealed, the spermatic cord was peeled off to the inner ring level. The sac was cut open on the anterior side, and the excess hernia sac was removed, and it was not necessary to peel off the posterior wall of the sac and closely perforate the intestinal tract. 2. Stitching the sac: Use only the 7-0 silk thread to make a simple outer purse suture, and then tighten the outer purse to suture and knot. The assistant supported the stump of the sac, and the surgeon carefully peeled the spermatic cord from the posterior wall of the sac with the stripper to reach the inner ring. 3. Repair the inner ring: return the stump of the sac to the extraperitoneal space of the inner ring. The inner ring and the transverse transverse fascia fissure were repaired intermittently with a 7-0 wire. The rest can be repaired by the Bassini method. complication Infection or intestinal cramps.