To Discuss The Method Of Open Surgery Treatment For Adult Recurrent Inguinal Hernia

Background and objectiveThe Inguina henia, which appears after repair sugury, is called recurrent inguinal hernia(recurrent hernia for short). After surgery, the recurrence of Adult inguinal hernia is common. According to Literature reports, the recurrence rate of traditional inguinal hernia repair methods is 10% to 15%; the postoperative hernia recurrence rate of tension-free repair is low, the domestic literature reports 0. 6% ~ 1. 6%, foreign literature reports 1% ~ 17%. There are laparoscopic surgical method and open surgical method repair in the treatment of recurrent hernia. And, the latter is still indispensable at presen. Opinions of experts are different on which way is the best in the open surgery at present. In order to explore the suitableway to treat recurrent hernia, the author do open surgical treatment of 104 cases from July 2013 to June 2015, as well as clinical observation and research. The general informationThe 104 cases of patients are randomly selected from our hospital.From july 2013 to June 2015.The male 101 cases(97. 1%), the female 3 cases(2. 9%);Age 24 ~ 82 years, the average age of(66 + 10) years;Comorbidity 15 patients with diabetes mellitus, 17 cases of obesity, elevated intra-abdominal pressure factors(urination difficulty, constipation, chronic cough, etc.) in 41 cases;The recurrent times 1 time of 72 cases(69. 2%), 2 times of 24 cases(23. 1%), 3 or more times of 8 cases(7. 7%);80 cases of Direct hernia(76. 9%), 21 cases of indirect hernia(20. 2%), in 3 cases of femoral hernia(2. 9%);The original repair methods 88 recurrent cases in traditional hernia repair(84.6%),10 recurrent cases in tension-free hernioplasty(9. 6%), recurrent cases in the above two methods which are used successively(5. 8%);Time to relapse after surgery is from 4 months to 56 years. MethodThe 104 patients are implemented tension-free repair again. First of all, choose incision section that is near the pubic bone nodules within the original incision, and extend outward according to exploratory surgery. After cutting skin and Subcutaneous scar tissus, freely dissociate cord at superficial inguinal ring esrtuary pubic tubercle, and separate the hernial sac to reveal hernia ring(outer ring), and then highly dissociate preperitoneal sac to free space. Finnaly, ensure the way to surgical repair by probing the groin area(the original incision point) abdominal wall defect situation and the original patch repair.Pure hernia ring patch repair, no matter whether the last operation is the traditional repair or hernia patch repair as long as the abdominal wall is strong and hernia ring orifice is less than 3 cm, the surgey can be done as fololws. Put the net patch to preperitoneal space after turning hernial sac into the abdominal cavity, spread out the wafer and the medial edge of behind the pubic bone nodules, and close hernia ring orifice narrow. Meanwhile, make 3 ~ 4 mesh plug petals fixed here; if hernia ringis from 3 ~ 5 cm, put Kugel wafers or PHS wafer into preperitoneal space and spread out them, close hernia ring orifice narrow and fix the leash here at the same time.Routine tension-free repair, when the original incision, whose abdominal wall is Weak and whose defects are obviously, or hernia ring orifice is more than 5 cm, the conventional tension-free hernia repair method will be taken. The surgey can be done as fololws. Extend the incision,and separate inferior aponeurosis of external oblique abdominis gap. After separation of hernial sac fell into the abdominal cavity, choose the methods such as Lichtenstein type, Rutkow type and preperitoneal space repair. On the basis of the wound bleeding, decide whether to place drainage tube.Stoppa approach repair, if abdominal wall is Weak and defect area is large,even inguinal ligament rupture the surgey will use larger Kugel patches or other patch repair by a Stoppa method. For the patient whose inguinal ligament rupture, the edge of the patch seam on the Cooper ligament, and pull two broken end of inguinal ligament docking repair suture, or borrow the patch bridge, fix two broken ends on the patch respectively. ResultAll cases are taken tension-free repair again, 68 cases hernia ring repair with patchs, 28 conventional tension-free repair, 8 Stoppa repair. All patients discharged without incision infection. during the follow-up visits for half a year to two year and a half, there is no hernia recurrence in patients. ConclusionThe main recurrent reason of traditional inguinal hernia repair is the tension of suture between different tissues; and as to the tension-free repair, it is the irrational operation, improper patchs selection and placement.Open tension-free repair is an effective treatment for recurrent hernia.We should follow the individual treatment principle with simple hernia ring repair, conventional tension-free repair, or Stoppa repair.