Modified subspermatocele displaced indirect inguinal hernia repair

Familiarity with the anatomy of the inguinal region is essential for the inguinal hernia repair. The inguinal canal originates from the inguinal inner ring (abdominal ring) and ends in the inguinal outer ring (subcutaneous ring). The inner ring is an oval crease on the transverse fascia, and its position is equivalent to about 1.5 cm above the midpoint of the anterior superior iliac spine and the pubic symphysis. The outer ring of the inguinal region is formed by the aponeurotic fibers of the external oblique muscle. The triangular fissure is on the outside of the pubic tuberosity. Treatment of diseases: inguinal hernia Indication Modified spermatic sacral submucosal displacement inguinal hernia repair is suitable for adults with weak abdominal muscles, the elderly and recurrent inguinal hernia. It is characterized by suturing the combined tendon on the pubic ligament to achieve the purpose of strengthening and repairing the posterior wall of the inguinal canal. Contraindications 1. Patients with acute diseases, lesions in the skin of the sputum, or severe cough, etc., increase the intra-abdominal pressure. 2. Elderly paralyzed patients with long-term survival and no serious symptoms are expected. Preoperative preparation 1. Repeat the detailed physical examination and necessary laboratory tests before surgery, paying special attention to the throat, heart, lung, blood and surgical site. 2. Complete the skin preparation in the operating area one day before the operation. 3. If there is an upper respiratory tract infection, chronic cough, chronic constipation or other conditions that increase the intra-abdominal pressure, it should be controlled before surgery. Surgical procedure 1. Incision, dissection of the hernia sac, hernia sac resection and high ligation and other steps with the Brazilian fascia inguinal hernia repair. 2. Lift the spermatic cord and touch the femoral artery in the middle of the middle part of the inguinal ligament. The inner side is the femoral vein. The finger is placed close to this as a marker, and the fascia transverse fascia is bluntly stripped inward and downward along the inner edge of the pubic symphysis. Pushing the loose connective tissue on the superficial surface reveals the pubic ligament. 3. From the inside and the bottom of the incision, suture the joint iliac crest on the pubic ligament with a thick non-absorbent suture, and sew 2 or 3 needles together. The first suture should pass through the ligament of the sac and then tighten the suture. When sewing the last needle, the left hand finger can be used to block the femoral vein to avoid damage. The free edges of the remaining intra-abdominal oblique muscles and the transverse abdominis muscles are then sewn on the superior inguinal ligament. 4. Put back the sperm. Rinse the wound. The aponeurosis, subcutaneous tissue and skin of the external oblique muscle were sutured intermittently in front of the spermatic cord. complication Bleeding during surgery Some have a large amount of bleeding, bleeding can be caused by damage to the following blood vessels: 1 pubic branch of the obturator artery (so-called corona mortis), refers to the obturator artery branch around the hernia sac; 2 abdominal wall artery; 3 movement ,vein. It is cumbersome to infuse the bleeding caused by the two blood vessels in the front, but as long as the incision is extended and the exposure is improved, these blood vessels can be ligated or sewn without causing a big problem. The problem caused by femoral injury is more serious. When the inguinal ligament is sutured, the suture is too deep, which may damage the femoral blood vessels and cause massive bleeding. It is best to withdraw the needle before ligating the damaged blood vessel, and locally stop the bleeding. If the pressure can not stop bleeding immediately, it is necessary to enlarge the incision, fully expose the injured femoral blood vessels, and then local compression to stop bleeding, or use fine needle suture to repair the blood vessel breach. 2. Cut off the vas deferens After accidentally injuring the vas deferens, it should be repaired immediately. The ends of the ends can be anastomosed by a very thin non-absorbent line; the inner support can also be made with a thin plastic tube, and the anastomosis can be sutured with a thin line, and the plastic tube can be removed after surgery. If there is an operating microscope at the site, the 6-0 thin wire can also be used for the end-to-end anastomosis. In this case, the inner support tube is not needed (Fig. 1.3.1.1.2-5). 3. Damage to the lower abdomen nerve The important nerves encountered during hernia repair include the inferior epigastric nerve and the inguinal hernia, in addition to the sensory branch of the radial nerve and the reproductive branch of the reproductive femoral nerve. Because the inguinal inguinal nerve is located under the aponeurosis of the external oblique muscle near the outer ring, it is easy to damage the nerve when the diaphragm is cut. In the Cooper method, the inferior epigastric nerve is easily damaged when the incision is made in the anterior rectus sheath of the rectus abdominis. Once nerve damage occurs, repair has no real value. The nerve ends can be clamped with silver clips after trimming to avoid neuromas. Due to the overlap and cross-linkage of the segmental distribution of the nerve, the affected part may feel numb gradually after the injury. Inadvertent suture of the suture may cause long-term symptoms. The reproductive branch of the reproductive femoral nerve may be damaged when the testicular muscle near the inner ring is severed. The patient may have a testicular testicular sag before the operation. In the process of repairing and suturing the tendon, if the inguinal ligament is sewed too deeply, the femoral nerve may be sewed sometimes, and the femoral nerve may be incomplete after surgery, and the patient may fall easily when walking. It can be recovered after removing the suture that sewn the nerve. 4. Injury to the testicular arterial blood supply In the process of free hernia sac, the vascular bundle that damages the spermatic cord should be prevented. These blood vessels are thin and difficult to repair. The internal spermatic artery begins in the abdominal aorta, and the distal testicular artery is the main arterial supply of the testes. The internal spermatic artery is connected to the spermatic cord in the inner ring plane. The external spermatic artery is a branch of the inferior epigastric artery. After the spermatic cord tissue is added, the vas deferens is passed through the inguinal canal to provide blood supply to the testicular muscle. It has an anastomosis between the inner and the inner spermatic artery. Due to the presence of the above-mentioned collateral circulation, slight accidental damage to the spermatic vessels does not cause serious consequences. However, in the case of recurrent hernia repair, occasionally the spermatic blood vessels can be transected, which may affect the testicular blood supply. This situation should be avoided as much as possible, otherwise it may cause testicular atrophy. 5. Damage to the abdominal organs In the repair surgery, each stitch should be very careful. Sliding sputum can damage the cecum or sigmoid colon. Due to the lack of knowledge of the sputum, until the sliding sputum is recognized, the intestinal wall may have been cut or the mesenteric vessels have been severed. The hernia sac is located on the anterior medial side of the spermatic cord, so the separation and incision of all hernia sacs should proceed from the front. Mesenteric blood supply enters from behind the sacral sputum, and separation in the latter often causes bleeding or intestinal necrosis due to blood supply disorders. This complication can be avoided by incision in the anterior medial side of the sacral hernia. In case of damage to the colon wall, the colon wall should be repaired as usual. The inside of the iliac crest often has a bladder wall. When the sac is cut open, the bladder can be cut due to carelessness. Seeing a blood-rich lemon-colored adipose tissue to be vigilant, it may be a pre-bladder lipoma, do not cut easily. Once the bladder wall is damaged, the bladder wall should be sutured in two layers with a fine chrome gut or absorbable suture and silk thread, while the catheter is indwelled through the urethra for several days. can be patched as usual.

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