Hernia sac angioplasty and high ligation

High ligation of the hernia sac is an extra-abdominal synovectomy for the treatment of sacral spasm. Treatment of diseases: abdominal inguinal hernia incision Indication Applicable to the general slippery, the length of the intestines is more than 5cm, but not more than 10cm. Contraindications Great slippery sputum is generally treated with transabdominal synovial repair. Surgical procedure 1 Bevan method: This is a more common method, but only for smaller sliding sputum, such as the cecum slipping out. The specific step is to cut the peritoneum and cut the peritoneum along the edge of the cecum 2cm at the edge of the cecum. The two ends of the margin must reach the neck of the sac to ensure a high ligation after forming a complete sac. Carefully free the cecum to the inner ring level to avoid accidental injury to the mesangial vessels and spermatic vessels. At this point, the cecum that slides out can be returned, and the ends of the curved cutting edge of the peritoneum are closed together for longitudinal suture to form a complete hernia sac for high ligation. (1) The peritoneum was cut in an arc along the edge of the cecum 1 to 2 cm. (2) The inner wall of the free cecum reaches the inner ring level. (3) The peritoneal curved cutting edge is sutured longitudinally. (4) After the cecum is returned, the sac is ligated at a high position. 2 La Roque method: for larger sliding sputum, such as sliding out of the long tube such as sigmoid colon, this method is more reliable. The specific step is to cut the anterior wall of the sac, and the posterior side of the free intestine is directly to the inner ring. If the sac is out of the intestine, the vascular can not be accidentally injured. Then, the intra-abdominal oblique muscle and the transverse abdominis muscle were separated in the direction of the muscle fibers 3 cm above the inner ring. Care should be taken not to damage the inferior epigastric nerve, and the peritoneum was cut, and the inner ring was returned to the free intestine and slipped out from the abdominal incision. The free side of the posterior side of the intestine is turned to the front, and the peritoneum of the wall between the hernia sac incision and the peritoneal incision is also turned over, and the excess hernia sac is cut off, so that the residual cutting edge can be sutured to cover the free surface of the intestine. It forms the serosa layer behind the mesangium and the returning intestinal tube. Finally, suture the peritoneal incision. (1) The dotted line is the transverse transverse fascia incision, and the anterior wall of the hernia sac is cut. 1. Abdominal oblique aponeurosis. 2. Intra-abdominal oblique muscles. 3. The transverse fascia. (2) The peritoneum was cut about 3 cm above the inner ring. (3) The freely slipped out of the intestine is raised from the abdominal incision through the inner ring. (4) The free surface of the intestine has been turned over to the front and serosalized. (5) Returning the intestines. (6) Stitching. 3 Ponka method: a surgical method suitable for large sliding sputum. First separate the sac with the slippery intestine and spermatic cord to the deep inner ring, be careful not to damage the mesenteric and spermatic vessels, cut the anterior wall of the sac and cut it to the deep side of the inner ring along both sides of the intestine, and then The two sides of the incision edge on the free surface of the intestine to form a complete inner ring to the suture, return to the intestine tube, and the high position ligation of the hernia sac. This procedure does not require peritonealization of the free surface behind the intestine. (1) Anatomy of the sac to the inner ring. (2) Cut the anterior wall of the sac. (3) Cut the peritoneum to the inner ring along both sides of the intestine. (4) The cutting edges on both sides of the peritoneum are sutured behind the free surface of the intestine to form a complete inner ring. (5) Returning to the intestine, the sac is highly ligated.