Novosti
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Year 2014 Vol. 22 No 4
GENERAL AND SPECIAL SURGERY
A.V. CHERNYH, E.N. LYUBYH, V.G. VITCHINKIN, E.I. ZAKURDAEV
ANATOMICAL JUSTIFICATION OF MODIFICATIONS OF MEDIATED PLASTIC REPAIR OF THE INGUINAL CANAL
SBEE HPE “Voronezh State Medical Academy named after N.N. Burdenko”,
The Russian Federation
Objectives. To modify the method of the mediated plastic repair of the inguinal canal.
Methods. The study was carried out on 39 unfixed male corpses with the inguinal hernias, who died at the age of 34-87 years. The number of persons with the direct inguinal hernia was 26 (66,6%), with the indirect hernias – 8 (20,5%), with supravesicalis hernias – 2 (5,1%), with inguinal-scrotal hernias – 3 (7,8%). The shape of the inguinal gap has been determined, the height, length of the inguinal gap and the width of falciform aponeurosis measured.
Results. The triangular shape of the inguinal gap was revealed in 25 (64,1%) cases, the oval-transitional form in 9 (23,1%) and the slotted-oval shape – in 5 (12,8%). Depending on the specific shape of the inguinal gap the method of basic suture application was modified at the mediated plastic repair of the inguinal canal. In the triangular gap the pubic tubercle periosteal and lacunare ligament are firstly sewed, then the thread through the falciform aponeurosis, the lower edges of the internal oblique and transverse abdominal muscles is passed. The suture is completed with the thread conduction through the inguinal ligament. In cases with the oval-transitional form of inguinal gap, the pubic tubercle periosteal and lacunare ligament are firstly sewed, then the thread is passed through the lateral edge of the rectus sheath, falciform aponeurosis, the lower edge of the internal oblique and transverse abdominal muscles have been sewed. Hereinafter falciform aponeurosis is sewed again, the suture is completed with a thread passing through the inguinal ligament. In the slotted-oval shape of the inguinal gap the pubic tubercle periosteal and lacunare ligament are firstly sewed, then the thread is passed through the falciform aponeurosis. The bridge of suture must lie on the anterior surface of falciform aponeurosis. The suture is completed by the second stitching of falciform aponeurosis and inguinal ligament.
Conclusions. A choice of modifications of the main suture at the inguinal canal mediated plastic repair should be implemented taking into account the shape of the inguinal gap.
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394036, Rossiyskaya Federatsiya, g. Voronezh, ul. Studencheskaya, d. 10, GBOU VPO «Voronezhskaya gosudarstvennaya meditsinskaya akademiya imeni N.N. Burdenko», kafedra operativnoy hirurgii s topograficheskoy anatomiey,
e-mail: ezakurdaev@rambler.ru,
Zakurdaev Evgeniy Ivanovich
Chernyh A.V. MD, professor, the first Vice-rector, a head of the operative surgery chair with the topographic anatomy of SBEE HPE “Voronezh State Medical Academy named after N.N. Burdenko”, the Ministry of Public Health of the Russian Federation.
Lyubyh E.N. MD, professor, director of scientific-research herniology center, professor of the faculty surgery chair of SBEE HPE “Voronezh State Medical Academy named after N.N. Burdenko”, the Ministry of Public Health of the Russian Federation.
Vitchinkin V.G. PhD, an associate professor of the operative surgery chair with the topographic anatomy of SBEE HPE “Voronezh State Medical Academy named after N.N. Burdenko”, the Ministry of Public Health of the Russian Federation.
Zakurdaev E.I. A post-graduate student of the operative surgery chair with the topographic anatomy of SBEE HPE “Voronezh State Medical Academy named after N.N. Burdenko”, the Ministry of Public Health of the Russian Federation.
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