Female Pediatric Inguinal Hernia Repair

Female pediatric inguinal hernia repair for the treatment of female inguinal hernia. The occurrence of inguinal hernia in children is mostly due to the patent of rupture of the processus vaginalis and not due to weak muscles. The vast majority are indirect hernia. Incarcerated hernia is much more common than in adults, but because of better tissue elasticity, strangulated hernia is less common. 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 overlap. The above characteristics determine the special requirements for surgical treatment of inguinal hernia in children, which is the main point of the narrative. Treatment of diseases: inguinal hernia Indication 1. Infants with inguinal hernia for more than 3 months, the chance of self-healing is very small, and it is more likely to occur in the embedding. Once the incision is closed, the intestine, ovary or fallopian tube will be involved, and the operation should be scheduled 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 not obvious. When the baby is especially cut into the subcutaneous tissue, it is always necessary to recognize whether the deep fascia is reached. It is characterized by a white surface shining, and its deep surface is fat-free after cutting. The 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 the need of the external annulus. The method is simple, but the position of the outer ring must be identified. 3. Transverse sac After the sac is cut, the round ligament of uterus is closely adhered to the posterior wall of the sac and cannot be separated from the sac. The sac should be cut off together with the posterior wall of the sac and treated with the sac wall. 4. Also accept the contents In addition to the small intestine, the contents of the female inguinal hernia are more common in the ovary and fallopian tubes. The ovary can be reconciled with the intestine; the fallopian tube is often located at the junction of the fixed and free part of the hernia sac, and should be prevented when the sac is sewed. If the fallopian tube forms part of the posterior wall of the sac, it is a kind of sliding sputum. At this time, if you want to return it, you must cut the sac around it to make the fallopian tube free, so that it can also be included in the pelvic cavity. After the fallopian tube is still returned, the posterior wall of the neck of the cut sac is cut and trimmed, and the inner bag is sutured, and the sac is ligated at a high position. The excess sac edge is removed along with the round ligament. If the inner ring is larger, the needles of the transverse fascia can be sutured intermittently to reduce the inner ring, reduce the chance of recurrence, and then suture the incision intermittently. It is generally not necessary to strengthen the repair of the front wall. complication 1. edema or hematoma of the vulva 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. Incision infection. 3. 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. 4. Surgery wrong side Emphasize that the surgeon checks the sick child before surgery and checks with the medical record and parents.