Pediatric Indirect Inguinal Hernia Repair

Pediatric inguinal hernia is mostly caused by congenital peritoneal sheath rupture, and the hernia sac often closes with the spermatic cord and testis. Because the child is in the development process, so only the high position ligation of the hernia sac is needed during the operation, and it is not necessary to remove the hernia sac and repair the posterior wall of the inguinal canal. Common methods include high ligation of the inguinal hernia sac and high transposition of the abdominal hernia sac. Treatment of diseases: inguinal hernia, inguinal hernia, incarcerated inguinal hernia Indication Infantile inguinal hernia, pediatric inguinal hernia. Surgical procedure High ligation of the inguinal hernia 1. Incision, revealing the hernia sac: On the pubic bone of the sick child, the skin at the outer edge of the rectus abdominis is naturally creased and made oblique. This incision needs to be slightly higher and flatter than the adult incision. After the subcutaneous superficial fascia was cut, the external oblique aponeurosis and the outer ring of the adult were observed. In children, the inguinal canal is shorter, mostly about 1cm. Pull the outer ring upwards with a small hook and then separate the cremaster muscle with a hemostatic forceps to reveal the spermatic cord and the sac. 2. Separate the hernia sac: separate the hernia sac, lift it with a hemostatic forceps and cut it open. The hernia sac incision was enlarged and the edges were lifted with a hemostat and spread out. Between the inner ring and the outer ring, a tissue is cut between the wall of the capsule and the spermatic cord, and the sac is separated sharply and the wall of the sac is transected. The upper part of the hernia sac is separated from the spermatic cord by gauze to the neck of the hernia sac. 3. Sewing the neck: Use the left hand to extend into the hernia sac, push the contents of the capsule back into the abdominal cavity, then twist the neck of the sac and then sew it, and cut off the excess upper sac. The lower half of the hernia sac does not need to be removed, and is placed back in the scrotum after hemostasis. Check the spermatic cord, do not distort, and prevent testicular blood supply disorders. 4. Stitching: After careful hemostasis, suture the cremaster muscle and the external oblique muscle aponeurosis. The subcutaneous tissue and skin are then sutured layer by layer. Transabdominal hernia sac high dissection 1. Incision: The incision of this procedure should be slightly higher than the incision through the inguinal route. A transverse incision of about 3 cm was made about 0.5 cm above the inner ring of the inguinal canal (corresponding to the natural fold plane of the lower side of the diseased side); the medial end of the incision originated from the outer edge of the rectus abdominis. After the skin and superficial fascia were cut, the external oblique aponeurosis was cut according to the size of the incision. The intra-abdominal oblique muscle was cut in the direction of the muscle fiber, and it was bluntly separated and pulled up. The transverse abdominis and peritoneum are then cut transversely along the skin incision into the abdominal cavity. Care should be taken to avoid the inferior and inferior epigastric vessels. 2. Exposing the sac of the sac: After lifting the peritoneum of the lower edge of the incision with a mosquito hemostatic forceps, the sac of the inner ring can be seen. Extend into the little finger to check the condition inside the sac. 3. Cut the posterior lip of the sac of the sac.: Use a few mosquito hemostatic forceps to lift the peritoneum of the posterior lip of the sac in the inner ring, and separate the ventricle along the posterior side of the posterior lip (ie, the lower side of the sac). 4. Suture the peritoneum: suture the upper edge of the peritoneal incision of the abdominal wall and the lower peritoneal edge of the posterior lip of the cut sac and suture with a thin thread to close the abdominal cavity. In this way, the hernia sac and the peritoneum near the inner ring can be placed outside the abdominal cavity, and the contents of the abdominal cavity can no longer enter the sac in the sac of the sac at the inner ring, thereby achieving the purpose of treating the sac in a high position. 5. Suture the abdominal wall: suture each layer of the abdominal wall layer by layer.

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