Presentation on the topic "Cerebral hernias in children." Strangulated hernias in children Modern methods of treatment of external abdominal hernias presentation

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Treatment Treatment of inguinal hernia is only surgical. The operation is recommended from the age of 6 months. As a rule, surgery for inguinal hernia is performed both in the “classic” open form with a linear incision in the groin area, and laparoscopically. The advantage of the laparoscopic method is the ability, during one surgical intervention, to identify and eliminate an inguinal hernia on the opposite side, which until now has not manifested itself in any way, but could appear in the future.

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Duhamel II Technique of surgery for inguinal hernia in children with Duhamel II. It is performed at the age of 5-6 years, when the inguinal canal enlarges and it is not possible to isolate the neck of the sac behind the inguinal canal. The skin is cut layer by layer to the aponeurosis of the external oblique muscle, which is exposed along with the external opening of the inguinal canal. Stepping 1.5 cm distally from it, cut the aponeurosis (1.5 - 2 cm long) and make a window in the anterior wall of the inguinal canal. From this window, among the tissues filling the inguinal canal, the neck of the hernial sac is found and separated from the elements of the cord. In the case of congenital hernias, the vas deferens is located medial to the hernial sac, the elements of the cord are “spread out” on it. The isolated hernial sac is cut, its contents are examined, and the internal organs are inserted into the abdomen. The hernial sac is pulled until its neck appears. The bag is sutured proximal to the neck, tied in both directions, the distal part is not cut off. The operation is completed by suturing the window in the anterior wall of the inguinal canal end to end, and layer-by-layer sutures are applied to the wound.

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The presentation on the topic “Abdominal Hernia” can be downloaded absolutely free on our website. Project subject: Medicine. Colorful slides and illustrations will help you engage your classmates or audience. To view the content, use the player, or if you want to download the report, click on the corresponding text under the player. The presentation contains 8 slide(s).

Presentation slides

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Hernial orifices are openings in the muscular aponeurotic layer through which, under the influence of various reasons, protrusion of the parietal peritoneum and internal organs of the abdominal cavity occurs. Hernial sac is part of the parietal peritoneum that has emerged through the hernial orifice. It is distinguished: The mouth is the initial part of the sac The neck is the proximal part of the hernial sac, located in the hernial orifice The body is the widest part located under the skin The bottom is the distal part of the sac Hernial contents are the movable organs of the abdominal cavity: omentum, loops of the small intestine, sigmoid, transverse colon and cecum, appendix, uterine appendages and uterus.

Components of a hernia

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Etiology of hernias

Factors leading to the formation of hernias: 1. Predisposing: local general 2. Producing: long-acting, short-acting

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Local predisposing factors are the anatomical and topographical features of the structure of the anterior abdominal wall with the presence of so-called “weak spots”. General predisposing factors are features of the human constitution that have developed as a result of hereditary and acquired properties, age and gender differences in body structure, weakening of the abdominal wall due to obesity and exhaustion, pregnancy and injury, as well as after heavy physical labor. Generating factors - factors that contribute to an increase in intra-abdominal pressure or its sharp fluctuations: constipation, flatulence, chronic cough, difficulty urinating, pregnancy, prolonged difficult childbirth, heavy physical labor, ascites

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Diagnosis of hernias

The examination allows you to determine the presence of a hernial protrusion, its shape, size, and location. Palpation allows you to determine the consistency of the protrusion, the size of the hernia defect, the reducibility and pain of the hernia. Percussion allows you to determine the contents of the hernial sac by percussion sound. Auscultation allows you to determine the contents by the presence of bowel sounds.

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Hernia treatment

Conservative: use of bandages with pelota for umbilical hernias in children, wearing a bandage if there are contraindications to surgical treatment 2. Surgical treatment

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Complications of abdominal hernias include: Strangulation Irreducibility Coprostasis Inflammation

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Strangulated hernia Strangulated hernia is the most common and dangerous complication requiring immediate surgical treatment. The organs that have entered the hernial sac are subject to compression (usually at the level of the neck of the hernial sac) in the hernial orifice.

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Pathological picture. In the strangulated organ, blood and lymph circulation are disrupted; due to venous stasis, fluid transudates into the intestinal wall, its lumen and the cavity of the hernial sac (hernial water). The intestine becomes cyanotic in color, the hernial water remains clear. Necrotic changes in the intestinal wall begin with the mucous membrane. The greatest damage occurs in the area of the strangulation groove at the site of compression of the intestine by the pinching ring.

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Clinical picture and diagnosis. Clinical manifestations depend on the type of strangulation, the strangulated organ, and the time that has passed since the onset of the development of this complication. The main symptoms of a strangulated hernia are pain in the hernia area and irreducibility of a previously freely reducible hernia. The intensity of pain varies; sharp pain can cause shock. Local signs of strangulated hernia are sharp pain on palpation, compaction, and tension in the hernial protrusion. cough shock symptom is negative. During percussion, dullness is determined in cases where the hernial sac contains an omentum, bladder, and hernial water. If there is intestine containing gas in the hernial sac, then a tympanic percussion sound is determined.

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Treatment If a hernia is strangulated, emergency surgery is necessary. It is carried out in such a way as to open the hernial sac without cutting the strangulating ring and prevent the strangulated organs from slipping into the abdominal cavity. The operation is carried out in several stages.

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Stages of surgical treatment of a strangulated hernia: Layer-by-layer dissection of tissue up to the aponeurosis and exposure of the hernial sac. Opening the hernial sac, removing hernial water. Dissection of the pinching ring under visual control, so as not to damage the organs soldered to it from the inside. Determination of the viability of strangulated organs. Indisputable signs of intestinal non-viability are dark coloration, dull serous membrane, flabby wall, lack of pulsation of mesenteric vessels and intestinal peristalsis. Resection of a nonviable intestinal loop. Plastic hernial orifice.

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Irreducibility of a hernia The irreducibility of a hernia is caused by the presence in the hernial sac of fusions of internal organs with each other and with the hernial sac, formed as a result of their trauma and aseptic inflammation. Irreducibility can be partial, when one part of the hernia contents is reduced into the abdominal cavity, while the other remains irreducible. Long-term wearing of the bandage contributes to the development of irreducibility. Most often, umbilical, femoral and postoperative hernias are irreducible. Due to the development of multiple adhesions and chambers in the hernial sac, an irreducible hernia is often complicated by strangulation of organs in one of the chambers of the hernial sac or the development of adhesive intestinal obstruction.

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Coprostasis Stagnation of feces in the large intestine. This is a complication of a hernia in which the contents of the hernial sac are the large intestine. Coprostasis develops as a result of a disorder of intestinal motor function. Its development is facilitated by the irreducibility of the hernia, a sedentary lifestyle, and abundant food. Coprostasis is observed more often in obese patients of senile age, in men - with inguinal hernias, in women - with umbilical hernias. The main symptoms are persistent constipation, abdominal pain, nausea, and rarely vomiting. The hernial protrusion slowly increases as the colon fills with feces, it is almost painless, slightly tense, of a doughy consistency, the symptom of a cough impulse is positive. The general condition of the patients is of moderate severity.

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Treatment of coprostasis It is necessary to achieve the release of the colon from its contents. With reducible hernias, you should try to keep the hernia in a reduced state - in this case it is easier to restore intestinal motility. Small enemas with hypertonic sodium chloride solution, glycerin or repeated siphon enemas are used. The use of laxatives is contraindicated due to the risk of fecal impaction. POSTOPERATIVE
VENTRAL HERNIA

Definition

Postoperative hernia (also known as ventral hernia,
cicatricial hernia) is a condition in which the abdominal organs
cavities extend beyond the abdominal wall in the area
scar formed after surgery.
After all laparotomies, hernias form in 3-5%.

Causes of postoperative hernia

Postoperative hernia is a consequence of earlier
performed surgical intervention.
The main reason is the divergence of the muscularaponeuratic layers of the anterior abdominal wall in the area
postoperative scar
The determining reasons for its development are:
–
–
–
–
–
–
–
–
suppuration and dehiscence of postoperative wounds
repeated relaparotomies
laparostomy
abdominal tamponade
peritonitis
incorrect operational access
errors in surgical technique
early physical activity

Predisposing factors for the development of ventral hernias

Excess body weight
Elderly and senile age
Bronchitis, pneumonia after surgery
Vomit
Constipation
Flatulence (bloating)
Inhibition of protective and regenerative
body capabilities

Most often postoperative
hernias complicate operations,
carried out in emergency or
urgently.
In this case, surgeons usually do not have time to
carrying out appropriate preoperative
preparation.
This leads in the immediate postoperative period to
intestinal dysfunction (bloating or passage
intestinal contents), and therefore to an increase
intra-abdominal pressure, respiratory disorders
functions, cough, which negatively affects the process
formation of a postoperative scar.

Classification of postoperative hernias

Egiev V.N., 2002:
– Small (occupies 1 area of the anterior abdominal
walls)
– Medium (occupies 2 areas)
– Large (occupies 3 areas)
– Giant (occupies more than 3 areas)
Yatsentyuk M.N., 1978:
–
–
–
–
–
Small – up to 5 cm.
Medium - from 6 to 15 cm.
Large - from 16 to 25 cm.
Huge - from 26 to 40 cm.
Giant - over 40cm.

Classification
ventral
hernias

ICD-10 classification

K43.0
Hernia of the anterior abdominal wall
without gangrene: causing
obstruction, strangulated,
irreducible, strangulation
K43.1
Hernia of the anterior abdominal wall with
gangrene, gangrenous hernia
anterior abdominal wall
K43.9
Hernia of the anterior abdominal wall
without obstruction or gangrene

An example of a hernia with trophic changes

Trophic changes in tissues in the area
gigantic postoperative hernia size
anterior abdominal wall.

SWR classification

S (size) - localization of hernia
M
Medial location
L
Lateral location
M.L.
Combined arrangement
W (windlas) - size of the hernial orifice
W1
Up to 5 cm.
W2
From 5 to 10 cm.
W3
From 10 to 15 cm.
W4
More than 15 cm.
R (relapse) - relapse
R1
First relapse
R2
Second relapse, etc.
An example of forming a diagnosis: Gangrenous hernia of the anterior
abdominal wall with acute intestinal obstruction (2 relapses),
located medially - K43.1 MW4R2

A – Patient P. Extensive median postoperative hernia. B – Patient M. Extensive postoperative hernia in the right iliac

areas.

A – Patient S. Giant postoperative hernia in the right hypochondrium. B – patient K. Giant median postoperative

hernia.

A - Patient I. Extensive right-sided lumbar postoperative hernia. B – Patient U. Extensive left-sided lumbar

hernia.

A – Patient D. Medium multiple postoperative hernias of the right hypochondrium and epigastrium. B – Patient Ya. Extensive

multiple postoperative
hernias of the right iliac, periumbilical and left
iliac regions.
A
B

A – Patient N. Giant postoperative hernia. B – Patient Ch. Giant postoperative hernia.

A - Patient M. Extensive upper-median postoperative hernia. B - Patient O. Extensive median postoperative hernia.

Symptoms of ventral hernias

A protrusion in the area is determined
postoperative scar, increasing with
straining and standing, decreasing
in a lying position.
Sometimes in the presence of large subcutaneous
pocket, the protrusion may be
slightly away from the skin scar.

Complications of postoperative hernias

The main complications of postoperative
hernias are:
–
–
–
–
–
Abnormal stool
Intestinal obstruction
Strangulated hernia
Neoplasms of hernia
Flatulence, etc.
But even in the absence of the above
life-threatening complications,
postoperative hernias lead to a decrease in
labor and physical activity, violation
quality of life!!!

Complications of hernias

Infringement
–
–
–
–
Inguinal – 57.3%
Thigh – 31%
Umbilical – 6%
Hernia of the white line – 3%
– Postoperative – 2.2%
– Other localizations – 0.5%
Inflammation
Damage
Neoplasms

Strangulated Hernia Clinic

Sharp pain.
Irreducibility.
Tension and increase in size.
Negative symptom of “cough impulse”.
Symptoms of OKN.
Leukocytosis, high ESR.
In the urine - protein, leached red blood cells,
cylinders (toxic nephritis).
8. Ultrasound and abdominal X-ray data.
cavities
1.
2.
3.
4.
5.
6.
7.

Treatment methods

Only surgically!!! (hernioplasty)
1.Removal of hernia and plastic surgery of the hernial orifice
own tissues - tension plastic. (practically not
applies)
2.Removal of hernia and repair of hernia orifices with mesh
grafts - tension-free plastic surgery (plasty according to
Liechtenstein).
Used in mature, elderly and senile patients
age. The most reliable method, since relapse is
According to the literature, it is 0.1-1%.

Surgical treatment

Stage 1 Operational access:
Wide border incisions with complete excision
postoperative scars, excess skin and pancreas.
Access selection:
– Epigastric region - longitudinal approaches
– Mesogastrium - transverse sections
– Hypogastric region - transverse or T-shaped (in case of obesity, the subcutaneous
fat apron).
Finish with complete isolation of the hernial sac and
edges of the hernial defect in the muscular aponeurotic
layer.

Operational accesses

Shape and
direction
skin incisions
at
postoperative
various hernias
localization.

Surgical treatment

Stage 2 - Opening of the hernial sac and separation
abdominal organs from its walls.
Operations for postoperative hernias should be
produce only intraperitoneally, which
allows you to examine those soldered to the hernial sac and
edges of a hernial defect of the abdominal wall of an intestinal loop
and omentum, separate them or partially resect them,
thereby reducing the risk of early
postoperative adhesive obstruction.

Excision of the hernial sac

For extensive and giant postoperative
in hernias the hernial sac is inappropriate
excise completely, since its parts, in
combinations with additional plastic
materials, can be used for plastics
hernia defect.
For small and medium hernias, when hernial
the gates are small and their edges can be brought together
duplication without noticeable tension, hernial
the bag is excised completely along the entire circumference.

Mobilization and excision of the edges of the hernial orifice

Hernial orifices in postoperative hernias are usually
have an irregular shape and can be separated
dense scar tissue into individual cells.
During the operation, all septa should be cut and
give the hernial orifice the appearance of an oval.
It is known that scar tissue heals very poorly or
does not fuse at all, since it is poor in blood vessels
vessels.
The use of scar tissue for plastic surgery is almost
inevitably leads to recurrence of the hernia, therefore
scar tissue in the plastic area should be
opportunities to excise!!!

Suturing a postoperative wound

Produced after thorough washing
antiseptic solution.
This allows you to remove loose pieces
fatty tissue and blood clots. Nodal
sutures match fiber and skin.
Drainage of the wound is mandatory
rubber strips for one day or vacuum drainage.

Abdominal wall plastic surgery

Autoplasty
Alloplasty
Among the autoplastic surgical methods
treatment of postoperative hernias greatest
Fascial-aponeurotic and muscular-aponeurotic have become widespread
plastics, mainly methods:
1.
2.
3.
4.
5.
Martynova
Napalkova
Sapezhko
Mayo
Sabaneeva-Monakova.

Autoplasty according to Martynov

Operation according to N.I. Napalkov for divergence of the rectus abdominis muscles.

Strangulated ventral hernia. Plastic surgery according to Sapezhko.

A - U-shaped sutures are applied, while
the right leaf of the aponeurosis is brought under the left.
B - a second row of interrupted sutures is applied with
formation of duplication.

Plastic surgery of the hernial orifice using the Sapezhko-Dyakonov method. Application of U-shaped seams

Plastic surgery of hernial orifices according to the method
Sapezhko-Dyakonova. Applying shaped sutures
Create a duplicate from
white aponeurosis flaps
vertical abdominal lines
direction by
overlays at first 2-4
U-shaped seams, like
how this is done with
Mayo method, with
subsequent hemming
interrupted edge seams
free flap
aponeurosis to the anterior wall
rectus sheath
belly.

The method of plastic surgery of hernial orifices for hernias of the anterior abdominal wall according to the Voronin-Smirnov method

Alloplastic methods of operations

Using transplants
For postoperative ventral hernias in
in each specific case provide
maximum possible use
the patient's own tissues (muscles,
aponeuroses, fascia, scar tissue, parts
hernial sac).
There are several
methods of application
transplants.

Method 1 (“Onlay technique”)

The hernial orifice is strengthened by suturing
graft over autoplasty. The edges of the hernial
the defect is sutured with interrupted sutures until tightly
contact or duplication.
Then the anterior surface of the muscular aponeurotic
layer is separated from the subcutaneous tissue for 8–10
cm from the suture line in both directions and the graft is sutured,
strengthening this suture line and weak points of the abdominal wall

Transplant
located
anterior to the musculoaponeurotic
layer
1 - skin and
subcutaneous
cellulose
2 - muscularaponeurotic
layer
3 - peritoneum
4 – transplant.

Alloplasty of the abdominal wall for ventral hernias. (“Onlay-technique”).

Method 2 (“Inlay technique”)

With the help of a graft, the wide
area of the abdominal wall from the inside, between
peritoneum and muscle layer.
After removal of the hernial sac and excision of scars
the peritoneum is peeled off from the muscular aponeurotic layer
for 6–8 cm. The edges are sewn together. Then over
a graft is placed in the peritoneum, one edge of which
it is fixed with U-shaped sutures to the muscularaponeurotic layer from the inside.
Then the second edge is hemmed so that
after bringing the edges of the hernia defect over
the plastic tissue remained taut with the graft,
“didn’t sail.”

Alloplasty of the abdominal wall for ventral hernias. "Inlay technique"

The graft is located behind
muscular aponeurotic layer
1 – skin and subcutaneous
cellulose
2 – muscularaponeurotic layer
3 – peritoneum
4 – graft

Method 3 (“Sublay technique”)

This method is used in cases where the seams are used to bring together
the edge of the hernial orifice is impossible or dangerous. From the walls
two opposite flaps are cut out of the hernial sac
6–8 cm wide and equal to the length or diameter
hernial orifice.
Using one of the flaps, tightly hemming it
edges to the opposite edge of the hernial orifice, close
abdominal cavity. Then to the edges of the hernia defect throughout
its circumference in the form of a patch is sewn onto the graft,
on top of which the second hernial flap is fixed
bag.

Alloplasty of the anterior abdominal wall “Sublay technique”

The graft is located between the leaves
hernial sac:
1 - skin and pancreas
2 - muscularaponeurotic
layer
3 - peritoneum
4 - graft

Complications of the postoperative period

Early postoperative period:
Wound suppuration
Pneumonia
Accumulation of serous fluid
Thrombophlebitis of the lower extremities
Late postoperative period:
Relapse of the disease
Hernias of other localization

Clinical examples of hernioplasty

Patient N. Giant postoperative hernia
belly. A – before surgery; B – 3 years after
operations.

Giant postoperative abdominal hernia. A – before surgery; B – 6 years after surgery.

Patient R. Giant postoperative abdominal hernia. A – before surgery; B – 2 years after surgery.

Giant postoperative abdominal hernia. A – before surgery; B – 1.5 years after surgery.

Extensive postoperative abdominal hernia. A – before surgery; B – 3 years after surgery.

Methods of plastic surgery for giant hernias with abdominal wall defects larger than 300–400 cm2

Method V.N. Yanova:
a – the dotted line shows the first
option of the middle and
pararectal incisions;
b – the dotted line shows the second
option of the middle and
pararectal incisions;
c – continuous lacing
autodermal stripe of edges
aponeurosis of the white line of the abdomen;
d – median laparotomy
wound sutured, pararectal
laparotomy wounds are closed
double autodermal
transplants.

Method V.N. Yanova
Autodermal strip
pass through the muscularaponeurotic edges
hernia defect on
at a distance of 3-5 cm from the edge
hernial orifice by
intertwining with hernia
gate in the form of a seam with
subsequent
straightening and
stitching together individual
strip stitches
adapting seams with
frame formation
from autodermal
stripes in the form of a lattice.

Method V.N. Yanova
Distinguished by
that autodermal
the strip is woven into
edges of the hernial orifice
by type of lacing,
with holding
stripes from the inside
outwards.

Laparoscopic hernioplasty

The method of laparoscopic treatment of hernias is
performing an operation using a small access
(in the form of a puncture with a diameter of about 2 cm).
The operation is performed using laparoscopic
technology.
This method has the advantage not only of using
smaller incision, but also to a lesser extent
traumatization of patient tissues and less frequency
complications during and after operations. Disadvantage
method is to perform laparoscopic surgery
under general anesthesia.

Prevention

Wearing a bandage after abdominal surgery
cavities
Proper nutrition
Weight normalization
Limitation of physical
loads after surgery

FACULTY

SURGERY

Saint Petersburg

2010

External hernia

abdomen (Hernia

abdominalis externa) a hernia in which

abdominal organs

cavities along with

covering them

parietal peritoneum

exit through

natural or

artificial

holes in the abdominal

wall while maintaining

skin integrity

covers.

ANATOMICAL CLASSIFICATION

EXTERNAL HERNIA - inguinal, femoral,

umbilical, perineal, lumbar;

hernia of the white line of the abdomen; hernia

Spigelian line; hernial protrusions,

exiting through the ischial or

obturator foramen;

postoperative hernias.

INTERNAL HERNIA diaphragmatic hernia;

hernias that form in the peritoneal

pockets and folds.

ETIOLOGICAL CLASSIFICATION

CONGENITAL HERNIA

CLINICAL CLASSIFICATION

REVERSIBLE HERNIA

The hernial contents are easily reduced into

abdominal cavity.

IRREVERABLE HERNIA

Hernial contents cannot be

completely reduced into the abdominal cavity.

STARGED HERNIA

There is an acute dysfunction and

blood supply to the hernia

sac of organs due to their compression in

hernial orifice.

COMPLAINTS

Nagging pain or

discomfort

in the hernial area

Objective research

Diaphanoscopy

X-ray methods

X-ray contrast herniography

X-ray contrast studies

hollow organs (if suspected

sliding hernia)

Laparoscopic diagnosis

1. Bassini method.

After incision of the skin and aponeurosis of the external oblique muscle and high removal of the hernial sac, the spermatic cord is completely isolated and retracted anteriorly. Then so-called deep sutures are applied.

They capture from above the lower edge of the internal oblique and transverse muscles, the transverse fascia. In the first two sutures from the pubic junction, the edge of the rectus muscle along with its sheath is captured and sewn for 5-7 cm to the inguinal ligament, and the periosteum in the area of the pubic tubercle is also captured in the first suture.

The spermatic cord is placed on the created muscle bed and the edges of the aponeurosis of the external oblique muscle are sutured on top of it with a series of interrupted sutures.

or the posterior wall of the inguinal canal.

These methods of plastic surgery are used for large, recurrent hernias in cases where it is impossible to repair the inguinal canal with local tissues. In these cases, free plastic surgery is used with the fascia lata of the thigh (Kirchner method, skin flap (Barnov method), or using alloplastic material (tantalum mesh, fabric made of nylon, nylon and other chemical materials).

Classification

Based on their origin, there are congenital and acquired hernias.

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Based on the location of hernias relative to the abdominal wall, they are divided into external and internal.

According to the anatomical structure and, accordingly, the place of their exit from the abdominal cavity, two types of hernias are distinguished: oblique (hernia inguinalis externa s.obligua) and direct (hernia inguinalis interna s.directa).

Due to the different options for placing the hernial sac, other types of inguinal hernias can rarely be observed: oblique with a straight canal, preperitoneal, intramural, encysted, peri-inguinal, supravesical, combined.

1) umbilical cord hernia (fetal hernia);

2) umbilical hernias in children;

3) umbilical hernias in adults

1. Elastic

2. Feces

3. Mixed

2. Chronic

Hernias develop gradually. During heavy physical activity, running, jumping, the patient feels tingling pain at the site of the forming hernia.

The pain is mild at first and does not bother much, but gradually intensifies and begins to interfere with walking and working. After a certain time, the patient discovers a protrusion, which comes out (appears) during physical activity and disappears at rest.

Gradually, the protrusion increases in size and takes on a round or oval shape. If the protrusion disappears at rest, in a horizontal position or by pressing with the hand, then such hernias are called.

Inguinal hernia

Inguinal hernia is a disease in which internal organs protrude through the inguinal fossae into the inguinal canal through the ungrown vaginal process of the peritoneum or into a newly formed hernial sac, which is located in the spermatic cord or outside it.

The largest number of inguinal hernias occur in the earliest childhood (1-2 years), when oblique congenital hernias appear. Inguinal hernia occurs more often in men (85-90%) and much less often in women. In most cases, women have indirect hernias; Direct hernias in women are rare.

1. Cherny's method. After bandaging and removing the sac, without opening the aponeurosis of the external oblique muscle, sutures are placed on its legs. Then 3-4 sutures are applied, capturing the formed fold of the aponeurosis of the external oblique muscle from above, and from below the aponeurosis just above the inguinal fold.

2. Ruja's method. After isolating, ligating and removing the hernial sac, without opening the aponeurosis of the external oblique muscle, starting from the external opening of the inguinal canal, 4-5 sutures are applied, capturing the aponeurosis of the external oblique muscle from above along with the muscles located under it, and the inguinal ligament from below.

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channel to its normal state.

1. Martynov's method. After removing the hernial sac, 4-5 stitches are placed between the edge of the upper flap of the aponeurosis of the external oblique muscle and the inguinal ligament. The lower flap of the aponeurosis of the external oblique muscle is placed over the upper one and fixed with sutures without much tension.

2. Girard's method.

After removing the hernial sac, the edge of the internal oblique and transverse muscles is sutured to the inguinal ligament in front of the spermatic cord. After this, the edge of the upper flap of the aponeurosis of the external oblique abdominal muscle is sewn separately to the inguinal ligament.

The lower flap is fixed over the upper one with several sutures, forming a duplicate.

channel.

Postempsky's method. The aponeurosis of the external oblique muscle is dissected closer to the inguinal ligament.

The spermatic cord is isolated. Then the internal oblique and transverse muscles are dissected to the lateral side of the deep opening of the inguinal canal in order to move the spermatic cord to the upper lateral corner of this incision.

After this, the muscles are sutured. The superficial fascia is sutured on top of the spermatic cord.

According to Lovkud, after dissecting the skin and subcutaneous base, the hernial sac is isolated, opened, and the contents are inserted into the abdominal cavity. The hernial sac is bandaged and cut off. Closure of the femoral canal is carried out by suturing the inguinal ligament to the periosteum of the pubic bone with 2-3 knotted sutures.

1. A modification of the Bassini operation is that after suturing the inguinal ligament to the periosteum of the pubic bone, a second row of sutures is placed on the semilunar edge of the oval fossa of the femur and the pectineal ligament.

suturing the stomach to the diaphragm around the esophageal opening with fixation of its lesser curvature to the abdominal wall to restore the acute angle between the fundus of the stomach and the abdominal part of the esophagus; used to treat reflux esophagitis and sliding hiatal hernia

1) elimination of infringement;

2) inspection of injured organs and, if necessary, appropriate interventions on them;

3)plasty of the hernial orifice