| 摘要 |
FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to herniology. If it is impossible to de-entrap and reduce hernia content under action of myorelaxants, laparoscopic instruments are removed, laparoports and pneumoperitoneum are preserved. Linear skin cut is performed on 3-5 cm, starting with the point, located 1.5-2 cm higher than projection on skin of pubic tubercle parallel to inguinal ligament. Subcutaneous adipose cellular tissue, aponeurosis and fibres of external inguinal ring, if it is entrapped, are dissected. Attempt to reduce entrapped organ is repeated. In case of entrapment in internal inguinal ring, retractor blade is introduced into wound along inguinal canal, its traction is performed by handle upward to create operation field. Slight incision of fibres of internal oblique and transverse muscles is made on valleculate probe, reduction is performed. Laparoscopic instrument is introduced and viability of de-entrapped organ is assessed. In case of direct inguinal hernia: in case of organ viability, hernia sac is reduced into abdominal cavity without opening or, in case of nonviability of de-entrapped organ, opening of hernia sac is performed, organ is extracted into wound, nonviable section is resected, in case of entrapped organ resection opened hernia sac is sewn before reduction. In case of oblique inguinal hernia: hernia sac is opened, sewn near base, dissected on anterior wall to the bottom without complete mobilisation and resection. Operation field in area of inguinal canal is created by traction by retractor handle upward, mobilisation is carried out and spermatic cord is taken on tourniquet, non-tension plasty of posterior wall of inguinal canal is carried out with synthetic transplant with hole for bringing out spermatic cord.EFFECT: increase of method efficiency.2 ex, 2 dwg |
