I. Mechanism of pediatric hernia: The internal ring opening (sphincter) is not closed, forming a pouch-like hernia sac. The abdominal contents enter the hernia sac through the unclosed internal ring opening, manifesting as a swelling in the inguinal and scrotal areas.
Second, the common purpose of various surgical treatments: to tie the internal ring opening so that the abdominal contents cannot protrude again.
Third, traditional surgery: inguinal incision, separation of the hernia sac from the abdominal wall, and ligation of the internal ring opening outside the abdominal cavity.
Disadvantages.
1. 2cm incision is required.
2. High requirements for the operator: familiar anatomy, good tissue discrimination, fine operation, and experience.
3. The separation of the trauma is extensive, and postoperative scrotal swelling is difficult to avoid and requires secondary surgery to remove the hematoma.
4. It is difficult to deal with complicated situations: for example, heavy scarring of the hernia sac neck. Therefore, the operation time is as long as 1-2 hours.
5, vas deferens injury, medical cryptorchidism, bladder injury, and even ureteral injury can not be 100% avoided (although these injuries are rare in clinical practice, they absolutely cannot be completely avoided, while laparoscopy can completely avoid these injuries, and for this reason, I personally think that traditional surgery may be completely replaced by laparoscopic surgery).
Fourth, laparoscopic surgery.
Advantages.
1, no scars: through the umbilical ring surgery, no scars after healing.
2. Surgery under direct vision is simple and clear, and the contralateral internal ring opening can be explored.
3. No treatment of hernia sac, 100% no risk of postoperative scrotal swelling, damage to vas deferens, testicular retraction, etc.
4. The operation time is fixed, about 10 minutes.
Disadvantages.
1. Special instruments are needed.
2. The cost is about 1000 yuan more than traditional surgery.
Seven, common questions answered.
1, the age of surgery: no specific provisions, heavy people can be operated just after birth; if recurrence is frequent, the possibility of self-healing is very small and there is a risk of life-threatening intestinal tube and testicular necrosis caused by compression of testicular blood vessels, there is no need to wait; if recurrence is not frequent, you can generally observe until 6 months old and then operate.
2, post-operative care problems: no need to stay in bed for a long time after surgery, general daily activities after discharge can be, as long as not strenuous activities.
3, anesthesia: our hospital are using high-grade inhalation anesthesia, fast onset, fast awakening, “anesthesia damage to the brain” is nonsense.