tension-free hernia repair

Tension-free hernia repair was invented by Dr. Li Jinstein, a hernia treatment expert at the Lichtenstein Center in 1984, the famous American hernia treatment center. The method covers the ankle defect with a mesh-filled patch that is well compatible with human tissue. The logic of this hernia surgery method is equivalent to using a rubber sheet to fill the hole in the tire. This method was named the Lichtenstein surgery. The method has been widely promoted because of its lack of tension, low recurrence rate, mild pain, less complications, quick recovery after surgery, and low cost. After the invention of the tension-free hernia repair by the Li Jin Stan Center, various surgical methods for repairing sputum with materials have emerged one after another. These hernia surgical methods have a variety of theoretical foundations, but are basically improvements in the shape of the repair material. Treatment of diseases: obturator Indication Particularly suitable for elderly patients, huge hernias and recurrent hernia patients. Contraindications There are no obvious contraindications. Preoperative preparation Reducing activity or reducing weight can temporarily relieve symptoms. Wearing a hernia strap (belly belt) can also temporarily relieve symptoms. Surgical procedure Step 1. Anesthesia: More choices of local anesthesia, can also be used for spinal anesthesia, children should use ether and general anesthesia. Local anesthesia method: 1% procaine solution, about 100 ml, first make an intradermal hillock on the inner side of the anterior superior iliac spine about 2 horizontal fingers, then infiltrate the tissue between the oblique internal oblique muscle and the transverse abdominis muscle. To block the inferior phrenic nerve and the inguinal nerve. On the outside of the pubic tuberosity, which corresponds to the inner upper side of the outer ring, the subcutaneous hillock is made, and the procaine solution is injected into the vicinity of the pubic periosteum and around the spermatic cord to block the local nerve. Then, between the two injection points, a diamond-shaped infiltration anesthesia (from the skin, subcutaneous tissue, fascia to the muscular layer) is performed, and if necessary, additional infiltration is performed along the incision. Step 2. Incision: 2 cm above the inguinal ligament, the incision from the midpoint of the inguinal ligament obliquely to the top of the pubic tuberosity (equivalent to the outer ring), the incision parallel to the inguinal ligament, incision of the skin and subcutaneous tissue, revealing a silvery white belly External oblique muscle aponeurosis and outer ring. Step 3. Separation of the sac Find the outer ring with your fingers, lift the external oblique muscle aponeurosis at the outer ring with the gums, carefully separate the deep tissue with the curved vascular clamp, push the gingival inguinal nerve under the aponeurosis, and use the straight scissors along the fiber direction. The membrane is cut open. Then, the blunt force is used to separate and push the two leaves of the aponeurosis, and the medial side of the oblique muscle, the transverse abdominis muscle and the aponeurosis arch (or the combined tendon) are exposed on the inner side, and the inner surface of the inguinal ligament is exposed on the outer side. Step 4. Cut off the contents of the cockroach Use the retractor to pull the iliac groin nerve and the intra-abdominal oblique muscle, the transverse abdominis muscle and the aponeurosis arch (or the combined tendon) together, fully reveal the cremaster muscle, separate the cremaster muscle along the muscle fibers, and see the sac. Sometimes, in order to help identify, the paralyzed patient coughs and can make the hernia sac impulsive and agitate. The surgeon gently lifted the hernia sac with the gums. The first assistant lifted the sac at another point 0.5 cm away, and cut the sac between the two points. The contents of the small intestine and omentum in the hernia sac are returned to the abdominal cavity. If there is adhesion, it should be separated first. Step 5. Separate the spermatic cord When the vascular clamp is used to clamp the edge of the sac incision, the left hand lifts the sac in the left hand, the left finger extends into the sac and the wall, and the right hand is wrapped with saline gauze, and the sac is used to blunt the sac and its surrounding tissue and spermatic cord. Separation. The spermatic vein and the vas deferens are located on the outside of the hernia sac and adhere to the sac. It should be carefully pushed open. In particular, care should be taken not to damage the vein and cause bleeding. Big here, do not blindly power, so as not to cut or accidentally injure the vas deferens. Step 6. Suture the mouth Free the neck of the sac of the sac, and then cut it in the middle. The sac is divided into two parts. Experts from Guangzhou Renai Hospital said that the proximal wall of the capsule was carefully removed with blunt force or scissors until the inner ring. Then, the hernia sac is retracted around with the vascular clamp, and then the visceral tissue in the exploration sac is completely returned to the abdominal cavity, and the silk is taken at the neck of the sac (at the inner ring) as a purse or through suture. The excess wall of the sac is cut off, and the distal end of the mouth of the bag is sutured once by a thread. The two sutures were respectively ligated from the deep side of the transverse abdominis aponeurosis arch through the transverse abdominis muscle and the intra-abdominal oblique muscles with a curved needle, in order to achieve the displacement of the sac sac stump to a high position, avoiding the intra-abdominal Press the purpose of pressing the point directly. If the inner ring is loose and wide, the number of needles in the vicinity of the transverse fascia can be sutured for repair and reinforcement. Step 7. Complete bleeding surgery The distal hernia sac should be completely or partially peeled off according to the degree of adhesion, or not peeled off at all. However, it is necessary to check the edge of the peeling and the peeling surface of the sac and the spermatic cord to properly and tightly stop bleeding. Step 8. Repair of the inguinal canal wall (Bassini method): Free and lift the spermatic cord with a gauze strip. In the deep side, the abdominal transverse aponeurosis arch (or combined tendon) was sutured intermittently with the thick side of the inguinal ligament, and sutured from 3 to 4 to 5 stitches from top to bottom. The last needle should be used to sew the abdominal aponeurosis arch (or combined tendon) on the periosteum of the pubic symphysis to prevent the leftmost end of the triangular void, which may cause recurrence of sputum after surgery. The distance between the needle of the inner ring and the spermatic cord can be controlled by a small fingertip, avoiding over-tightening and causing blood circulation disorder of the spermatic cord. Step 9. Place the spermatic cord in a new position, and check again that there is no bleeding, and suture the external oblique muscle aponeurosis with a thick thread. The subcutaneous and skin layers are sutured in layers. Tension-free hernia repair with double-layer repair device The integrated abdominal mesh with a larger helium gap is used to repair and strengthen the damaged abdominal wall gap. The overall structure includes two upper and lower artificial mesh sheets and a connecting middle shaft. The middle shaft of the net is used to block the helium gas gap. The upper and lower artificial mesh can be attached to the inner and outer sides of the damaged abdominal wall. The anti-pressure principle of dam repair can strengthen the anti-stress, block the pressure of the abdominal wall, and will not increase the tensile force of the abdominal wall, reducing the possibility of postoperative pain and recurrence. Sex. Selection of artificial mesh: In this procedure, Lightweight Partially Absorbable Mesh is selected, which is a new type of retinal membrane developed by using modern technology. It originated from Europe and can be used in the treatment of inguinal hernia. Its main feature is Some materials can be absorbed, and the holes are large, so that the foreign matter remains less, and it is easy to form a scar tissue which is more elastic and fits the abdominal wall structure. Using the traditional hernia net membrane, patients often complain of long-term pain caused by limited abdominal wall activity, or feel the foreign body sensation of hernia net membrane. However, larger holes and partially absorbable materials The light-weight artificial omentum reduces the amount of the omentum in the human body, and also reduces the tissue inflammatory reaction caused by the omentum implanted in the human body. complication Many years of surgical application showed no further complications after the operation, no serious or persistent postoperative pain, and a low recurrence rate.