Laparoscopic hernia surgery steps

1. Incision of the peritoneum:

The peritoneum was incised at the upper edge of the hernia defect from the medial fold of the umbilicus to the anterior superior iliac crest, and the peritoneal flaps at the upper and lower edges were freed and entered into the preperitoneal space. There are two points to note: (1) the medial side should not exceed the medial umbilical fold to avoid damage to the bladder; (2) the inferior epigastric artery and vein should be avoided when incising the middle peritoneum. All operations are performed behind the transverse abdominal fascia without opening the transverse abdominal fascia.

2. Treatment of hernia sac:

If there is a "lipoma" outside the hernia sac, it should be removed, otherwise the "lipoma" will slide into the inguinal canal, causing recurrence similar to "extraperitoneal sliding hernia". Pull out the hernia sac from the abdominal wall defect and return it to a high position in the abdominal cavity, and separate the hernia sac from the level of the inner ring orifice from the spermatic vessels and vas deferens behind it by about 5-150px. The method is called "abdominalization of the spermatic cord," and its purpose is to ensure that a patch large enough will lie flat on the spermatic cord components without curling.

3. Placement of the patch:

The principle of patch repair is to replace the transverse abdominal fascia to cover the entire myopubic foramen and overlap with the surrounding muscular and bony tissues. The coverage of the patch is the same as the separation of the preperitoneal space above. Specifically, the upper part of the patch should cover the syndesmotic tendon 2-75px, the outer side should reach the anterior superior iliac spine, and the inner side must cover the rectus abdominis and the pubic tubercle and exceed it. The midline, below the medial side, is inserted into the pubic-vesical space without directly overlying the bladder.

4. Closure of the peritoneum:

The peritoneum can be closed with absorbable sutures, hernia fixation pins, etc. The peritoneal closure must be tight to avoid postoperative intestinal adhesions.

5. Postoperative treatment:

Patients can resume a liquid or semi-liquid diet 6 hours after laparoscopic hernia surgery, and can resume normal food 24 hours after surgery. On the second day after the operation, the patient can move around, go home, and resume normal activities one week after the operation.