Inguinal hernia repair

Inguinal hernia often occurs in the elderly, mostly caused by the weakness of the abdominal wall, and is different from the inguinal hernia caused by congenital defects. Therefore, when repairing, attention should be paid to strengthening the local abdominal wall. Treatment of diseases: inguinal hernia Indication Inguinal hernia often occurs in the elderly, mostly caused by the weakness of the abdominal wall, and is different from the inguinal hernia caused by congenital defects. Therefore, when repairing, attention should be paid to strengthening the local abdominal wall. Contraindications The patient is too old and should be filled with poor general condition. Preoperative preparation Antibiotics are routinely used before surgery. Surgical procedure 1. Expose the direct protrusion: the skin incision should be slightly inside the oblique repair. The aponeurosis of the external oblique muscle is incised, the combined tendon is pulled up, and the spermatic cord is pulled down to reveal the outer protrusion and the adjacent tissue structure. 2. Circular incision Base abdomen transverse fascia: After separating and pulling apart the spermatic cord, firstly lift the straight protruding part upwards in the upper side, and cut the abdomen transverse fascia of the base of the iliac crest with a knife ring at the lower edge. Then, the straight iliac crest is opened outward and downward, and the transverse fascia of the upper edge of the base of the iliac crest is also cut. The iliac crest protrudes from the groin triangle on the inner side of the inferior epigastric artery. Therefore, when the outer side of the base is cut, the abdominal wall should be avoided. Lower artery. After the entire base portion is circularly cut, the distal edge of the incision transverse fascia is lifted up by a hemostat, and the part of the transverse fascia is eversioned into a cup shape and peeled off. 3. Separation of the hernia sac: separation of extraperitoneal fat, showing a straight sac. The hemostatic forceps were used to clamp the top of the sac, and the sac was separated sharply from the bladder along the wall of the sac. Finally, the sac was completely separated. In this way, both the size and the sac can be safely cut for processing. 4. Cut the sac: The sac must be cut, whether it is a sacral repair or a straight sac. If the sac is gently lifted and not cut, only the neck of the sac is simply ligated, which can not achieve the purpose of high ligation, and may accidentally injure the viscera. Cut and lift the hernia sac and carefully check the relationship between the hernia sac and the surrounding tissue; pay special attention to the inferior epigastric artery on the outside of the rectus neck, while the closed umbilical branch of the internal iliac artery is often in the sac The inside of the neck. 5. Excision of the hernia sac and suturing the capsular neck: The contents of the sputum are placed back into the abdominal cavity, and after clearing the sac, the wall of the sac is removed from the neck of the sac. Because the neck of the sacral neck is generally wide, it is not easy to suture the inner purse or simply suture, so the intermittent suture is often closed. The suture should use a 4-0 silk thread, the first layer is a discontinuous suture, and the second layer is a discontinuous 8-shaped suture. A straight sac with a diameter of less than 3 cm and a wide base can not sever the transverse fascia and the sac, and suture a row of varus sutures on the transverse fascia at the bulge, so that the ridge portion is folded and inverted, and then Halsted The method repairs the posterior wall of the inguinal canal. 6. Repair the inguinal canal: When suturing the posterior wall of the inguinal region, suture the transverse fascia with a 4-0 silk thread. The combined tendon and the inguinal ligament are then sutured. The aponeurosis of the external oblique muscle was sutured and the spermatic cord was placed outside the aponeurosis of the external oblique muscle, and the subcutaneous tissue and skin were finally sutured. complication Nerve injury to the lower abdominal wall. The vas deferens are damaged. Testicular blood damage.