Transinguinal Hernia Repair

The femoral hernia accounted for 5% of the total abdominal hernia, which occurred in women over the middle age. There are many opportunities for incarceration in the femoral hernia, so it is advisable to repair it early. The diagnosis of femoral hernia is often difficult and even misdiagnosed. If the laparotomy is performed according to intestinal obstruction if it is not detected before surgery, it will cause difficulty during surgery. Therefore, patients with adult intestinal obstruction, especially female patients, should routinely check the thigh before surgery to avoid omission. The principle of the femoral hernia repair is basically the same as that of the inguinal hernia repair, mainly the high ligation of the hernia sac and the repair of the closed femoral canal. Intraoperative prevention should be done to avoid damage to adjacent tissues, especially the bladder, small intestine, and obturator arteries. Treatment of diseases: femoral hernia Indication There are many opportunities for incarceration in the femoral hernia, so it is advisable to repair it early. Contraindications The age of the body is weak, the vital organs such as the heart and lungs are poor, and the surgery does not restore hope. Preoperative preparation 1. To determine whether the diagnosis is oblique or straight, or whether the two coexist, whether it is slippery, whether there is incarceration or strangulation. 2. A detailed understanding of the severity of intestinal obstruction, dehydration, shock, etc., as well as serious diseases of the whole body, and actively take appropriate prevention and treatment measures. 3. Empty the bladder before surgery. Surgical procedure 1. Incision: the same as the incision of the inguinal hernia repair [see inguinal hernia repair. 2. Exposing the hernia sac: first cut a small opening in the proximal part of the external oblique aponeurosis in the upper part of the inguinal canal, and then cut it downwards. When the uterine round ligament is exported to the outer ring, the outer ring is cut with the forceps, so be careful not to damage. The groin nerve is separated from the groin, and the uterine round ligament is separated into the deep part. The gauze strip is overlaid and pulled outward and downward to expose and cut the transverse fascia. The extraperitoneal fat is separated, and the extraperitoneal projection of the femoral hernia (the sac) is seen at the femoral canal. After clamping the peritoneum with two small curved hemostats, the incision was opened, and the contents of the sputum were gently pulled back from the peritoneal incision and examined. If the contents are incarcerated and difficult to pull out, the ligament must be cut to enlarge the femoral ring. When cutting, first pull the hemostat of the peritoneum to the outside, and insert the finger with the left hand between the peritoneum and the crypt ligament in the neck of the femoral sac; if the abnormally originated obturator should be ligated, then cut again. Open the ligament of the sulcus. After this treatment, when the intestine is still difficult to pull out, the inguinal ligament of the anterior wall of the femoral ring should be partially cut or Z-shaped to further loosen the femoral ring. Check the intestine, if it is not necrotic, it can be put back into the abdominal cavity to treat the hernia sac; if it has been necrotic, the necrotic intestinal fistula should be presented from the upper part of the inguinal ligament, and the intestinal resection and anastomosis should be performed. Care should be taken during operation to avoid contamination of the field. 3. High position resection of the hernia sac: After separating the hernia sac from the superficial groin of the inguinal ligament, the peritoneal incision is opened, and the large hemostatic forceps are used to plunge into the femoral sac to find the lower end of the sac. The adhesion around the sac is separated outside the sac, and the lower end of the sac is pushed up with the left hand. Then use the hemostat to clamp the bottom of the sac, pull out and separate, and lift the entire sac from the peritoneal incision, so that the sac is turned outward. The sac was removed along the highest point of the sac neck, and the peritoneum of the sac of the sac was sutured with a 4-0 silk thread. In the operation of removing the sac in the high position, care should be taken to avoid damage to the external iliac vessels outside the field. 4. Repair the femoral tube: 0.5cm from the medial side of the external iliac vein to the pubic iliac crest, suture the pubic ligament and inguinal ligament with a 4th wire, and the innermost 1 needle can suture the ligament of the sac. When suturing, you need to use the left hand to protect the external iliac vein to avoid injury. Do not place the first needle suture too close to the vein to avoid the leakage of the saphenous vein and femoral vein. Then, the cut transverse fascia is sutured. 5. Stitching: After careful hemostasis, put the uterine round ligament back to the original place, suture the ecchym, subcutaneous tissue and skin of the external oblique muscle layer by layer. complication The fascia is compressed when the abdominal cavity protrudes.