Male Pediatric Inguinal Hernia Repair

Male pediatric inguinal hernia repair is used to treat male infantile inguinal hernia. The incidence of inguinal hernia in children is mostly due to the patentus vaginalis, but not because of muscle weakness. The vast majority of indirect hernia incarcerated hernia is much more than that of adults, but because of The tissue elasticity is better, so strangulated hernia is less likely to occur. Sliding hernia and bilateral hernia are also relatively common in children. In addition, the pediatric tissue is slender and weak, and the recognition of fascia level and anatomical boundary is different from that of adults; the inguinal canal is relatively short, that is, the inner ring is close to the outer ring, and the two are almost overlapping; at the same time, the development of the child is not yet mature, and the reproduction is Organ protection is especially important. The above characteristics determine the special requirements for surgical treatment of inguinal hernia in children, which is the main point of the narrative. The surgical principle of inguinal hernia in children is high ligation of the hernia sac, which does not require special repair. Actually, it is suture. Treatment of diseases: inguinal hernia Indication 1. Infants with inguinal hernia are more than 3 months old, the chance of self-healing is very small, and it is easy to occur in the embedding. Once embedded, it not only affects the intestine, ovary or fallopian tube, but also can cause testicular atrophy, and should be selected early. 2. If the incision of the inguinal hernia is unsuccessful, the operation should be performed immediately; the elective surgery after successful maneuver reduction should be performed after 48 hours. Preoperative preparation 1. Choose good conditions for children's health, especially to avoid respiratory infections, diarrhea, constipation, dysuria and local skin infections. 2. Clean the skin the day before surgery. 3. Fasting 6 to 8 hours before surgery. 4. Selective surgery can be performed in the clinic to minimize the psychological impact of hospitalization or other factors on the sick child and prevent preoperative embedding. 5. The embedding sputum should be operated as soon as possible. When the intestinal obstruction is obvious or suspected to be strangulated, the nasogastric tube should be placed under decompression, and the fluid and electrolyte should be replenished intravenously. Surgical procedure Incision The transverse incision along the skin wrinkles on the pubic symphysis was about 3 cm long. An oblique incision parallel to the inguinal ligament can also be made, from the midpoint of the inguinal ligament to the pubic iliac crest. 2. Expose the deep fascia and look for the outer ring Pediatric subcutaneous fat is thick and the superficial fascia is thin and inconspicuous. In infants, especially when the subcutaneous tissue is cut, it is always necessary to recognize whether the deep fascia is reached (in the inguinal region, the external oblique aponeurosis is in the groin, and in the outer ring is raised Testicular fascia), which is characterized by a white shiny surface. After cutting, its deep surface is fat-free, and its inner surface is more white and bright, showing the fiber direction. Confirm the external oblique muscle aponeurosis, cut along the fiber direction, be careful not to damage the deep inferior temporal iliac crest and the inguinal nerve, open the outer ring to the inside. In infant surgery, because the inner ring is close to the outer ring, the sacral aponeurosis and the outer ring of the external oblique muscle can be opened without treatment. The method is simple and convenient, but the position of the outer ring must be identified. The spermatic cord is tense, and it is touched along the tightened spermatic cord to the pubic tubercle, until the spermatic cord suddenly disappears, that is, the outer ring. 3. Find and open the sac In the inner and front of the spermatic sac, whether or not the outer ring is opened, it is necessary to use a mosquito clamp to gently separate the thin cremaster muscle and its fascia to reveal a white membranous sac. As long as the part is correct, the sac should be easy to find. If you are looking for difficulties, you must re-identify the anatomical relationship, that is, find the inner and outer rings from the inner surface of the inguinal ligament, and present the spermatic cord completely, and find the sac in the front. If there is difficulty, and then intra-abdominal exploration, that is, in the deep upper surface of the superior iliac sacral aponeurosis, separate the intra-abdominal oblique muscle and the transverse abdominis muscle, open the peritoneum, find the fistula through the abdominal cavity, so as to avoid aggravating the groin Department damage. Locate the sac, lift the sac wall with two mosquito tongs, cut between them, often a little clear liquid overflow, expand the sac incision, and find out the inner mouth of the abdominal cavity and the blind pocket of the sac . 4. Transverse and high ligation of the sac Use a few mosquito-type pliers to lift the thin sac of the sac in the sac of the transverse sac. Lift the thin wall of the sac. Use a blunt-cut to push the spermatic cord behind it. Be careful not to damage the vas deferens as thin as the white line. Cut the posterior wall of the sac, lift the edge of the sac near the end of the sac, and completely retract the sputum. The operator supports the finger in the hernia sac to facilitate the separation of the proximal end of the hernia sac to the inner ring. The sac is very thin, and the separation is as gentle as possible to avoid breakage. If the neck of the sac is narrow, the 1-0 silk thread can be sutured through the suture at the high position of the inner ring; when the neck of the sac is larger, the inner purse should be sutured. The high ligation of the hernia sac should be done to ensure that the contents of the abdomen are not caught, and that the wall folds and the voids remain. The excess sac is cut off at the proximal edge, and the stump is naturally retracted into the deep side of the internal oblique muscle. No special treatment is required after hemostasis at the edge of the distal hernia sac. 5. Suture incision After the wound is tightly stopped, the aponeurosis of the external oblique muscle can be sutured in situ. The reconstruction of the outer ring must be able to show the fingertips of the surgeon, and pay attention to whether the testicles have been included in the scrotum. A small number of children with large and inferior muscle fascia in the inguinal region can suture the medial lobe of the external oblique aponeurosis or the combined tendon before the spermatic cord and the inguinal ligament, and then overlap the lateral leaf of the aponeurosis. On the inside leaf. Finally suture the subcutaneous tissue and skin. complication Scrotal edema or hematoma Due to the surgical operation, the tissue damage is too heavy and the hemostasis is imperfect. Generally, it can be absorbed by itself, and the hematoma absorption takes a long time. If the hematoma is progressively enlarged and the pain is aggravated, the incision should be opened immediately to remove the hematoma, stop bleeding, drain, and suture. 2. Testicular high fixation or atrophy The surgery pulls the testicles back and does not put them back in place. The wound should be opened to reset it. Testicular atrophy caused by spermatic cord injury is irreparable. 3. Incision infection. 4. Hydrocele formation More often due to stenosis or stenosis of the distal capsule. The residual sac port should be opened during surgery. If the effusion has occurred, try to puncture the aspiration. 5. Recurrence Because the other tissues were mistaken for the sac, and the sac was not treated, the sac was not traversed and the sac incision was sutured, which was mistaken for high ligation; missed sacral sputum; incomplete sac ligation; groin muscle The film is too weak to be repaired. The above reasons should be avoided. 6. Surgery wrong side Emphasize that the surgeon checks the sick child before surgery and checks with the medical record and parents.