Inguinal sliding hernia

　　Inguinal sliding hernia refers to a hernia in which the organs and/or their mesentery protrude from the inguinal canal to form part of the hernia sac. Sliding hernias are not common, lack characteristic clinical manifestations, and are not easily diagnosed before surgery. However, due to the structural characteristics of sliding hernias, they are not easily reducible, so they often manifest as irreducible hernias.

　　In addition to general symptoms, it can also cause other diseases. During the sliding process, due to repeated friction, the abdominal organs of this condition are prone to adhesion with the hernial sac, forming a refractory hernia. Therefore, once found, it needs to be treated actively, and preventive measures should also be taken in daily life.

　　Sliding hernia is not common, and there are no characteristic clinical manifestations, making it difficult to make a diagnosis before surgery. However, based on the structural characteristics of sliding hernia, it is not easy to be completely reduced, so it often manifests as a refractory hernia. Elderly, obese, and patients with a long history who have difficulty reducing the hernia mass, or can only be partially reduced, should consider the possibility of sliding hernia.

　　There is currently no effective preventive measure for this condition. Early detection and early diagnosis are the key to the prevention and treatment of this condition. The patient's diet should be light and easy to digest, with more vegetables and fruits, a reasonable diet, and attention to adequate nutrition. In addition, patients should also pay attention to avoiding spicy, greasy, and cold foods.

　　In the diagnosis, in addition to relying on clinical manifestations, auxiliary examinations are also needed. This condition, sliding hernia, is not common and has no characteristic clinical manifestations, making it difficult to make a diagnosis before surgery. This condition seriously affects the patient's daily life, so it should be actively prevented.

　　Postoperative dietary recipes for inguinal sliding hernia:

　　1. Take 4 grams of Jilin ginseng and 3 grams of American ginseng with lean meat.

　　2. Boil 4-5 dried mushrooms with lean meat or chicken breast (drink the soup).

　　3. Take 15 grams of beiqi, 21 grams of dangshen, 30 grams of huai shan, and 15 grams of lianzi with lean meat.

　　4. Take 30 grams of tuifuling, 30 grams of raw yiren, and 3 pieces of yuanrou with grass carp or water turtle.

　　5. Take 17 grams of dangshen, 21 grams of shi shi, 10 grams of jiazi, and 15 grams of yiren with lean meat or chicken.

　　6. Take 3 grams of Tianqi, 3 grams of ginseng (or red ginseng) with lean meat or chicken.

　　All should be treated surgically. The key points of the operation are to first free the protruded organ, reduce it, and then reconstitute a complete hernial sac before performing high complete ligation and hernia repair surgery.

　　First, hernia sac shaping and high ligation

　　1. Bevan method:This is a relatively common method, but it is only suitable for smaller滑动性疝, such as the cecum slipping out. The specific steps are to incise the hernial sac and then incise the peritoneum in an arc shape 2 cm along the margin of the cecum. The two ends of the incision must reach the neck of the hernial sac to ensure that a complete hernial sac can be formed for high ligation. Carefully free the cecum to the level of the internal ring, avoiding injury to mesenteric and spermatic vessels. At this point, the slipped cecum can be reduced, and the two ends of the arc-shaped incision of the peritoneum can be aligned and sutured longitudinally to form a complete hernial sac for high ligation.

　　(1) Incise the peritoneum in an arc shape along the margin of the cecum 1 to 2 cm.

　　(2) The posterior wall of the cecum reaches the level of the internal ring.

　　(3) Suture the arcuate margin of the peritoneum longitudinally.

　　(4) Reduce the cecum and ligate the hernial sac high up.

　　2. LaRoque method:This method is suitable for larger sliding hernias, such as when the prolapsed bowel is longer like the sigmoid colon, this method is more reliable. The specific steps are to cut the anterior wall of the hernial sac, free the posterior side of the bowel to the internal ring, if the prolapsed bowel is longer, pay attention not to damage the mesenteric vessels during the free process. Then, separate the internal oblique and transversalis muscles in the direction of the muscle fibers about 3 cm above the internal ring, pay attention not to damage the iliohypogastric nerve, cut the peritoneum, pull the free and prolapsed bowel back through the internal ring and pull it out from the abdominal incision, the free surface of the original bowel behind is flipped to the front, the parietal peritoneum between the hernial sac incision and the peritoneal incision is also flipped out, remove the excess hernial sac, so that the residual incision margin can be sutured together, cover the free surface of the bowel to form the serosal layer behind the mesentery, reduce the bowel into place, and finally, suture the peritoneal incision.

　　(1) The dashed line is the incision of the transversalis fascia, cut the anterior wall of the hernial sac: ① External oblique aponeurosis; ② Internal oblique muscle; ③ Transversalis fascia.

　　(2) Cut the peritoneum about 3 cm above the internal ring.

　　(3) Pull the free and prolapsed bowel through the internal ring from the abdominal incision.

　　(4) The free surface of the bowel has been flipped to the front and has been serosalized.

　　(5) Reduce the bowel into place.

　　(6) Suture.

　　3. In addition, Ponka introduces a surgical method suitable for larger sliding hernias:Firstly, separate the hernial sac along with the prolapsed bowel from the deep surface of the internal ring to the deep surface, paying attention not to damage the mesentery and the vessels of the spermatic cord, cut the anterior wall of the hernial sac and cut along both sides of the bowel to the deep surface of the internal ring, then suture the two lateral margins behind the free surface of the bowel to form a complete internal ring, reduce the bowel into place, ligate the hernial sac high up, and this operation does not require the peritonealization of the free surface behind the bowel.

　　(1) Dissect the hernial sac to the internal ring.

　　(2) Cut the anterior wall of the hernial sac.

　　(3) Cut the peritoneum along both sides of the bowel to the internal ring.

　　(4) Suture the lateral margins of the peritoneum behind the free surface of the bowel to form a complete internal ring.

　　(5) Reduce the bowel into place and ligate the hernial sac high up.

　　2. Hernia Repair:The characteristics of sliding hernia are that the hernial ring is dilated, and the strength of the tendinous membranes of the abdominal wall layers and the transversalis fascia is severely damaged, so the commonly used methods are Bassini, Halsted, or McVay.