Strangulated Indirect Inguinal Hernia Repair

After the inguinal hernia is strangulated, in addition to local intestinal necrosis, more serious is the imbalance of intestinal obstruction and systemic water and electrolytes, which must be treated urgently. Gastrointestinal decompression should be performed before surgery to quickly replenish water and electrolytes and transfuse blood if necessary. Respiratory vomiting must be considered during anesthesia to cause fatal asphyxia. Treatment of diseases: recurrent inguinal hernia inguinal hernia Indication After the inguinal hernia is strangulated, in addition to local intestinal necrosis, more serious is the imbalance of intestinal obstruction and systemic water and electrolytes, which must be treated urgently. Contraindications There are serious obstacles to the coagulation mechanism. High blood pressure, diabetes, and some bleeding-prone diseases. Preoperative preparation Gastrointestinal decompression should be performed before surgery to quickly replenish water and electrolytes and transfuse blood if necessary. Respiratory vomiting must be considered during anesthesia to cause fatal asphyxia. Surgical procedure 1. Exposing and incision of the hernia sac: The surgical incision can be extended 2 to 3 cm downward according to the general inguinal hernia repair in order to facilitate exposure. Do not cut too deep when cutting, because the outer layers of the sac are thinned due to the swelling and compression of the contents, and it is easy to cut into the sac and accidentally injure the contents. 2. Loosen the inner ring stenosis: After cutting the sac, the stenosis of the inner ring is loosened as soon as possible to relieve the narrowing of the intestinal tract. At this time, a grooved probe or hemostat can be carefully placed between the narrow inner ring of the anterior and posterior aspect of the sac neck and the contents of the tendon, and then the inner ring can be cut along the groove or between the slightly open jaws to avoid damage. Content and nearby organs. At the same time, care should be taken not to slide the necrotic intestine into the abdominal cavity. 3. Treatment of strangulated intestinal fistula: After the strangulation is relieved, the narrowed necrotic intestine in the entire hernia sac should be incised together with the proximal and distal part of the normal intestinal fistula, and the incision should be strictly protected from contamination, and then the inspection and treatment should be performed. Narrow bowel fistula. The vitality of intestinal fistula can be judged according to color, temperature, elasticity, peristalsis, mesenteric vascular pulsation and liquid color and odor in the sac, and the striation is relieved. It is heated by warm saline gauze pad or temporarily put back into the abdominal cavity for 5 to 10 minutes. After that, the color of the intestine tube should be changed to ruddy, the intestinal wall is elastic and hardness, the serosal membrane of the intestine is restored to luster and smoothness, the intestinal tract can be stimulated to produce intestinal peristalsis, and the mesenteric blood vessels recover. If there is still suspicion through the above treatment, it is better for the elderly patients to remove the intestinal fistula; and the infant or child should be cautious, can be placed back into the abdominal cavity, and closely observed after surgery. 4. Repair the inguinal canal: After the intestine is finished, it can be repaired and sutured according to the "inguinal hernia repair". complication stomach ache.