Valenti Gabriele, Baldassarre Emanuele, Conforti Andrea
Department of Surgery, San Pietro Hospital-Fatebenefratelli, Rome, Italy.
Surg Today. 2005;35(8):645-8. doi: 10.1007/s00595-005-3014-7.
The integrity of the internal inguinal ring (IIR) is essential to prevent the occurrence of indirect noncongenital inguinal hernia. Marcy first considered the importance of the IIR and proposed the use of annuloplasty to repair indirect primitive hernias. His procedure involved the resection of the cremaster muscle. We modified Marcy's annuloplasty by sparing the cremaster muscle and herein review our experience.
We retrospectively reviewed a group of 213 male adult patients who were treated with annuloplasty of IIR for sliding or large indirect hernias, which was performed under local anesthesia as day cases. The median follow-up was 4.7 years (range 2-7 years).
There were no complications due to annuloplasty and the overall recurrence rate at follow-up was zero.
In our hernioplasty we prefer an anterior approach to avoid contamination with prosthetic materials of the zone under the transversalis fascia. The transversalis fascia remains an important anatomical barrier and the cremaster a natural diaphragm between the mesh and funicular structures. We believe that annuloplasty is effective in all types of hernias where a sliding or large indirect hernia is observed.
腹股沟内环（IIR）的完整性对于预防后天性腹股沟斜疝的发生至关重要。马西首次认识到IIR的重要性，并提出采用环缩术修复先天性腹股沟斜疝。他的手术方法包括切除提睾肌。我们通过保留提睾肌对马西的环缩术进行了改良，在此回顾我们的经验。
我们回顾性分析了一组213例成年男性患者，这些患者因滑动性或巨大腹股沟斜疝接受了IIR环缩术，手术在局部麻醉下作为日间手术进行。中位随访时间为4.7年（范围2 - 7年）。
环缩术未出现并发症，随访时总的复发率为零。
在我们的疝修补术中，我们更倾向于采用前路手术，以避免补片材料污染腹横筋膜下方区域。腹横筋膜仍然是一个重要的解剖屏障，提睾肌是补片与精索结构之间的天然隔膜。我们认为环缩术对所有观察到滑动性或巨大腹股沟斜疝的疝修补均有效。
