Patent RU-2403876-C1 (RU)
Title: Method of surgical management of medium indirect and direct inguinal hernias
Inventor: GUSHCHIN SERGEJ ANATOL EVICH
IPC: A61B17/00
Filed: 2009-06-23
Granted: 2010-11-20
Abstract: FIELD: medicine. 
     SUBSTANCE: invention refers to medicine, particularly to surgery, and can be used for surgical management of medium indirect and direct inguinal hernias. It involves anterior extraperitoneal approach to the inguinal canal, the hernial sac is separated and treated. It is followed with plasty of the transverse fascia with modelling of the internal hernial ring, and with plasty of the posterior wall of the inguinal canal. The inguinal space is closed with a formed inferointernal flap of the abdominal external oblique muscle aponeurosis extended from the inguinal ligament with a relative elongation due to dissection of the surface leaf of the fascia lata throughout a lower portion 2/3-3/4 of the inguinal ligament. The inferointernal flap is formed as follows: an inferior flap of the abdominal external oblique muscle aponeurosis is dissected transversally in a point that corresponds to the external half-thickness of the spermatic cord on escaping from the internal hernial ring. An incision depth of the flap of the abdominal external oblique muscle aponeurosis is determined by pulling the flap upwards and delivering to the mid-thickness of the spermatic cord on escaping from the internal hernial ring. The transverse muscle of abdomen is separated from the transverse fascia along the internal edge of the inguinal trigone, while the inferointernal flap of the abdominal external oblique muscle aponeurosis is freely fixed starting from the pubic spine along the perimeter of said flap to the transverse fascia with single interrupted sutures. The inferointernal flap of the abdominal external oblique muscle aponeurosis is placed under the abdominal internal oblique and transverse muscles with dead-end closure of the inguinal space and reinforcement of the internal inguinal ring. The inferointernal flap of the abdominal external oblique muscle aponeurosis is fixed to the abdominal internal oblique muscle, thereover with single sutures. The superior, inferointernal and inferoexternal flaps of the abdominal external oblique muscle aponeurosis are freely sutured along a line from a transverse incision angle of the dissected inferior flap of the abdominal external oblique muscle aponeurosis to the pubic spine behind the spermatic cord to form an external inguinal ring without involving the abdominal internal oblique and transverse muscles. The superior flap of the abdominal external oblique muscle aponeurosis is sutured to the pubic spine through the coating inferointernal flap of the abdominal external oblique muscle aponeurosis. It is possible to suture the superior, inferointernal and inferoexternal flaps of the abdominal external oblique muscle aponeurosis after a relief incision of the superior incision of the abdominal external oblique muscle aponeurosis directly over the pubic spine transversally to the fibre direction over the spermatic cord to form a new inguinal canal and the external inguinal ring. 
     EFFECT: method allows to close the inguinal space. 
     2 ex, 13 dwg