Subspermatocele displacement inguinal hernia repair

Treatment of diseases: inguinal hernia Indication The subdural ecchymosis of the inguinal hernia is suitable for adult patients with large hernia sac and weak abdominal wall. It is characterized by the displacement of the spermatic cord between the intra-abdominal oblique muscle and the external oblique muscle aponeurosis. Contraindications If the patient with inguinal hernia does not have a cuff or a strangulation, surgery should not be performed under the following conditions. 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 Anesthesia and position Local anesthesia (for weak abdominal wall) or spinal anesthesia. Children with general anesthesia or basic anesthesia plus local anesthesia. Generally used in the supine position. Surgical procedure 1. Begin to the pubis nodules at 1.5 to 2.0 cm above the midpoint of the inguinal ligament, and make a oblique incision parallel to the inguinal ligament, 6 to 8 cm long. The skin and subcutaneous tissue were dissected to reveal the aponeurosis of the external oblique muscle, and the outer end of the incision was exposed. 2. Along the direction of the aponeurosis of the external oblique muscle, make a small incision in the middle of the aponeurosis, lift the aponeurosis on both sides, use the scissors to sneak under the aponeurosis, and then cut the aponeurosis and the outer ring upwards and downwards. Injury of the inferior tibia and inguinal hernia under the diaphragm. 3. Peel and separate the aponeurosis to the sides, fully revealing the inner surface of the inguinal ligament and the joint iliac crest. The inferior epigastric and inguinal nerves are carefully removed from the surface of the abdominal oblique and testicular muscles, and are retracted to the sides to protect the outside and below the aponeurosis of the external oblique muscle. 4. Longitudinal separation of the testicular muscle and transverse transverse fascia fibers, revealing the hernia sac. The sac is located on the anterior medial side of the spermatic cord and is slightly grayish white. When the difficulty is identified, the patient may be coughed, or the nostrils may be pinched to make him suffocate. It is often seen that the sac is protruding along the spermatic cord. 5. Lift the wall of the sac, first cut a small opening on the wall with a knife, and then use scissors to enlarge the incision, taking care not to damage the contents of the sputum. Then, through the incision, the index finger is extended into the abdominal cavity, the position of the inferior epigastric artery is found, and the presence or absence of the second ankle is recognized. 6. Return the contents of the sputum to the abdominal cavity. In the middle of the hernia sac, the spermatic cord and the surrounding tissue outside the sac are peeled off, so that the middle part of the sac is completely free. The sac is cut off horizontally, and after careful hemostasis, the distal sac is placed in the scrotum. Do not sew the distal sac of the sac, so as not to form effusion or blood in the sac. 7. The proximal hernia sac is lifted with a hemostatic forceps. The left hand shows the inner surface of the sac. The right hand shows the gauze and continues to peel the proximal sac to the neck. During the stripping process, be careful not to damage the spermatic vessels and the vas deferens. 8. Retract the intra-abdominal oblique muscle and the lower edge of the transverse abdominis muscle to the outside. The purse is sutured with a medium-sized silk thread about 0.5 cm above the neck of the sac, and the purse is wrapped around the circle and knotted. If necessary, it is ligated at the distal side. 9. About 0.5cm distal to the ligature line, cut off the excess sac wall, use the two ends of the ligature, after the needle is inserted through the abdomen transverse muscle and the back of the abdominal oblique muscle, and then ligated, will The neck of the sac is fixed there. 10. Lift the spermatic cord and pass a gauze strip underneath it for traction while separating the testicular muscles and the transverse fascia around the spermatic cord. 11. If the inner ring has a large defect, or the fascia at the inner ring has been cut, the abdominal transverse fascia at the inner ring should be sutured before the repair, or an "8" shape suture can be made first. However, the suture should not be too tight, and the inner ring should be able to accommodate a small fingertip. 12. Retract the spermatic cord, starting from the lower part of the incision, suture the joint iliac crest and the inguinal ligament with a thick non-absorbable suture, and suture about 4 or 5 needles, each needle is about 1cm apart, the first needle The periosteum behind the pubic tuberosity should also be sewn together so that no triangular voids are left there. When suturing the inguinal ligament, the needle should be placed close to the posterior direction to avoid damage to the femoral artery and vein. The needle insertion and exit points of each needle should be selected on different planes to avoid tearing the inguinal ligament when the suture is ligated. The last needle should be careful not to let the spermatic cord at the inner ring be compressed. 13. Remove the gauze strip for traction and put back the spermatic cord to return the retracted nerve to its original position. Rinse the wound. In the front of the spermatic cord, the external oblique muscle aponeurosis is sutured with a thin non-absorbent line. The outer ring should have a space that can accommodate the passage of a small fingertip, so that the blood supply of the spermatic cord is not affected. 14. Suture the subcutaneous tissue and skin with a thin, non-absorbable layer. If there is more bleeding in the incision, a rubber sheet can be placed under the skin for drainage. The drainage is usually removed within 48 hours after surgery. complication 1. Bleeding during surgery. 2. Cut off the vas deferens. 3. Damage to the lower abdomen nerves. 4. Damage to the arterial blood supply of the testicles. 5. Damage to the abdominal organs.