METHOD OF PREPERITONEAL INGUINAL HERNIOPLASTY THROUGH MINI-ACCESS Russian patent published in 2019 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention refers to surgery, namely to abdominal surgery and hernioplasty. Transverse mini-access is performed 4 cm higher than pubic spine from outer edge of rectus muscle towards iliac wing. Transverse incision of the transverse fascia of the abdomen is performed for 4–5 cm. Preperitoneal space is introduced. Then, a petal laparoscopic retractor is used to shift the preperitoneal tissue and the peritoneum towards a posterior abdominal wall. Under the direct visual control by the gauze swab, the preperitoneal tissue is separated from the upper branch of the pubic bone with the visualization of the inferior venous plexuses and vessels along the posterior surface of the pubic bones. One proceeds with separation of the preperitoneal tissue along the median line behind the pubic ligament and penetrates into the prevesical cellular space 2–3 cm below the upper edge of the upper branch of pubic bone. Performing hemostasis of small preperitoneal and prevesical vessels with unipolar or bipolar electrocoagulation. Medial angle of the wound is used to introduce 30 Ch diameter Foley catheter into the prevesical cellular space between the bladder bottom and the pubic joint; the catheter balloon is inflated by adding 50–100 ml of 0.9 % sodium chloride solution into the catheter balloon. Retracted retractor is removed from the wound, hernial sac is to be treated. Sodium chloride solution is then removed from the catheter balloon, the Foley catheter is removed from the wound, the prevesical and preperitoneal cellular spaces are examined for haemostasis, and the implant is implanted.

EFFECT: method enables preventing development of massive and hard-to-control intraoperative bleeding, prevention of postoperative complications – hematoma in the perivesical space, atony of the bladder, due to bleeding stopping using the Foley catheter balloon and refusal to use the gauze pad, reducing intraoperative injuries, facilitating mesh implant expansion due to transverse incision of transverse fascia of abdomen.

1 cl, 3 ex, 3 dwg