Novosti
Khirurgii

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Year 2020 Vol. 28 No 4

PEDIATRIC SURGERY

M.A. AKSELROV 1, 2, S.M. PANTELEEV 1, A.V. STOLYAR 2, A.V. MARGARYAN 1, L.V. VIHAREVA 1

CLINICAL ANATOMY, TYPES OF OBLIQUE CONGENITAL INGUINAL HERNIAS AND FEATURES OF LAPAROSCOPIC HERNIORRHAPHY

Tyumen State Medical University 1,
Regional Clinical Hospital No2 2, Tyumen,
The Russian Federation

Objective. To optimize the operation of the extraperitoneal laparoscopic hernia repair in children by LASSO method, using the individual approach to carrying out a ligature depending on the anatomic type of the internal inguinal ring revealed on diagnostic laparoscopy.
Methods. Case histories (n=350) of children, from January, 2018 till May, 2019 were analyzed. There were 256 boys (73,14%) and 94 girls (26,86%). The age of children varied from 1 to 204 months. The operation method in all patients was the modified LASSO technique. The point was to use the original device for implementation of an extracorporeal ligation of the internal inguinal ring. Direct intraoperative data, such as the type of an inguinal ring and duration of operation were evaluated retrospectively.
Results. 545 inguinal rings on the right and on the left (taking into account uni- and bilateral inguinal hernia) were revealed. There are five types of rings: type 1 – with slit-shaped opening, slit shaped; type 2a – with a triangle shaped opening, triangular without peritoneal folds; type 2b – triangular with peritoneal folds; type 3a – oval without peritoneal folds; type 3b – oval with peritoneal folds.
Type 3a was the most common type of ring (n=246). Type 2b (n=45) was the most rare. Implementation of the additional manipulator was carried out in 33 cases, in 22 of them the ring was of 3b type. In these 22 patients (24 inguinal rings) the reduction of mean duration of operation with 39,58±5,82 min. up to 20±5,77 min was obtained.
Conclusion. In laparoscopic treatment of inguinal hernia it is necessary to consider visual structure of an internal inguinal ring. There are five types of them in total: 1, 2a, 2b, 3a, 3b. When the internal inguinal ring (3b type) is revealed, it is necessary to introduce an additional trocar for the manipulator that facilitates extra peritoneal carrying out ligature during such operation and significantly reduces intervention duration.

Keywords: inguinal hernia, children, internal inguinal ring, inguinal region, laparoscopic hernia repair, pediatric surgery
p. 404-411 of the original issue
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Address for correspondence:
625027 Russian Federation,
Tyumen region, Tyumen, Melnikayte str., 75, 2
Regional Clinical Hospital No2,
Surgical Unit No1
tel.: +7 92 22 67 52 92,
e-mail: stolyar.al@yandex.ru,
Stolyar Aleksandr V.
Information about the authors:
Akselrov Mikhail A., MD, Head of the Pediatric Surgery Department, Tyumen State Medical University, Head of the Surgical Unit No1, Regional Clinical Hospital No2, Tyumen, Russian Federation.
https://orcid.org/0000-0001-6814-8894
Panteleev Sergei M., MD, Head of the Department of Human Anatomy, Topographic Anatomy and Operative Surgery, Tyumen State Medical University, Tyumen, Russian Federation.
https://orcid.org/0000-0002-3006-6620
Stolyar Aleksandr V., Pediatric Surgeon, the Surgical Unit No1, Regional Clinical Hospital No2, Tyumen, Russian Federation.
https://orcid.org/0000-0002-0704-5418
Margaryan Artur V., MD, Professor of the Pediatric Surgery Department, Tyumen State Medical University, Tyumen, Russian Federation.
https://orcid.org/0000-0003-3497-8157
Vikhareva Larisa V., MD, Professor of the Pediatric Surgery Department, Tyumen State Medical University, Tyumen, Russian Federation.
https://orcid.org/0000-0001-6864-4417
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