Shafik A
Am J Surg. 1980 Sep;140(3):431-6. doi: 10.1016/0002-9610(80)90184-1.
A technique for repair of indirect inguinal hernia is presented. The hernial sac stump is invaginated in an attempt to secure high ligation of the sac and obliterate any residual peritoneal diverticulum. Four hundred forty-two patients were operated on. The technique consists essentially of division of the internal spermatic fascial tube at the neck as well as embedding of the sac stump by purse-string sutures in a narrow neck of Lembert sutures in a wide neck. The defect in the fascia transversalis is closed over the stump. Three hundred eighty-one patients were followed up 2 to 15 years, with a recurrence rate of 1.6 percent. The concept that in indirect hernia the problem involves the sac rather than the defect is put forward. Recurrence results essentially from the existence of a handmade sac rather than an improperly repaired defect. The role of invagination of the sac in securing complete excision of the sac and proper closure of the defect is discussed. In initiating recurrence, the part played by the redundant peritoneum deep to the internal ring is emphasized. Changes in the dynamics of intraabdominal tension induced by stump embedding are explained.
本文介绍了一种间接性腹股沟疝的修复技术。将疝囊残端内翻，试图确保高位结扎疝囊并消除任何残留的腹膜憩室。对442例患者进行了手术。该技术主要包括在颈部切断精索内筋膜管，以及用荷包缝合将疝囊残端埋入宽颈部的伦伯特缝合窄颈部。腹横筋膜缺损在残端上方闭合。对381例患者进行了2至15年的随访，复发率为1.6%。提出了间接疝问题涉及疝囊而非缺损的概念。复发主要是由于手工制作的疝囊存在，而非修复不当的缺损。讨论了疝囊内翻在确保疝囊完全切除和缺损正确闭合中的作用。强调了内环深部多余腹膜在引发复发中所起的作用，并解释了残端埋入引起的腹内张力动力学变化。
