Dissecting free and intact hernia sac off the spermatic cord preparing it for ligation during herniotomy and orchiopexy in children is time consuming and it dose not increase the incidence of recurrence as far as the deep ring is narrowed with one or two stitches so it introduce the tip of the little finger only.
Also, dissection deep in the deep ring has the advantage of giving length to the spermatic cord when operating on orchiopexy.
Dissection deep in the deep ring will create an inflammatory process with its associated oedema which last about 48 hours. During this time, the deep ring is closed by the oedema and an underlying pavementation of the peritoneum at the deep ring accomplished.
High dissection dep in the deep ring is recommended.
There are two separate points: 1. If orchidopexy is being done and there is an associated small hernia (small length of peritoneal sac), a high dissection with repair of posterior wall suffices.
2. if there is a large appreciable hernia, it is always better to do a herniotomy.
In orchidopexy identification of peritoneal sac and dissection till the deep ring helps in lengthening the cord
In Herniotomy always identify and ligate sac at deep ring to prevent recurrence
Complete dissection of the spermatic cord is mandatory, high ligation of the sac is on disuse, sac reduction, and internal ring repair with polydioxanone stitch (modified Marcy repair) is the best way to resolve inguinal hernia in children.
Theo chúng tôi khi phẫu thuật cho người lớn thì cần bóc hết túi thoát vị vì không bóc hết sẽ tiết dịch sau mổ nhưng mổ thoát vị bẹn ở trẻ em thì không cần bóc hết túi thoát vị mà chúng ta chỉ cần cột chặt túi thì cũng an toàn, khó tái phát sau mổ
Hiện nay theo nhiều nghiên cứu, phẫu thuật điều trị thoát vị bẹn khoong có tái phát
Yes, identification and high ligation is mandatory to prevent recurrence
Tôi rất đồng ý tách hết túi thoát vị giúp thừng tinh dsif hơn, rất thuận lợi trong trường hợp tinh hoàn ẩn. Vì giúp phầu thuật viên thuận tiện khi đưa tinh hoàn xuống bìu. - Tôi nghĩ khi tách túi thoát vị nhiều quá thường sau phẫu thuật thùng tinh phù nề mà đặc biệt dễ chảy máu sau mổ.
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