Method for fixing testicle when lowering it into scrotum

Abstract

FIELD: pediatric surgery and urology.SUBSTANCE: tunnel to the scrotum is formed from the groin area using a finger or a gauze swab. A transverse incision of the scrotal skin, the length of which is equal to the maximum size of the testicle to be brought down, is made along the skin fold in the lower third of the scrotum, 1-2 cm away from the root of the scrotum, and a subcutaneous cavity is formed with a clamp to accommodate the testicle. The testicle is then inserted into the scrotum, stitched with a nylon thread in the area of the ligament of the tail of the epididymis, placed in a physiological position and fixed with a nylon thread to the fleshy membrane in the area of the bottom of the scrotum. Next, the entrance to the scrotum is narrowed by placing two separate interrupted absorbable sutures at the level of the initial section of the spermatic cord immediately above the testicle and the head of the epididymis, capturing in the sutures the edge of the testicular membranes, the remainder of the vaginal process in which the testicle was located. Then skin sutures are applied to the scrotal wound.EFFECT: ensuring sufficient trophism of the testicle with its reliable fixation, even with pronounced tension of the spermatic cord, and the absence of relapses of the disease (postoperative dislocation of the testicle).1 cl, 5 dwg, 1 ex

Description

[0001] The invention relates to medicine, namely to pediatric surgery, urology and andrology, and can be used in all cases requiring fixation of the testicle in the scrotum with or without tension of the spermatic cord.

[0002] The closest in technical execution is the Petrivalsky-Schumacher method of fixing the testicle, which consists of fixing the descended testicle at the bottom of the scrotum between the skin and the dartos with two sutures (Pediatric Surgery: National Guidelines edited by Yu.F. Isakov, A.F. Dronov, 2009).

[0003] The disadvantage of the known method is the fixation of the testicle in a non-physiological position (inverted), the presence of relapses.

[0004] The technical result of the claimed method is the physiological position of the descended testicle in the scrotum, ensuring sufficient trophism of the testicle with its reliable fixation, even with pronounced tension of the spermatic cord, the absence of relapses of the disease (postoperative dislocation of the testicle).

[0005] The technical result is achieved by fixing the testicle at three points: at the bottom of the scrotum, and by narrowing the scrotal entrance at the level of the initial section of the spermatic cord, with simultaneous fixation of the testicular membranes at the site of narrowing at two points. The duration of the surgical procedure is no longer than that of commonly used methods and takes up to 30-40 minutes.

[0006] The method is performed as follows. The method is illustrated (Figure 1-5 - stages of testicular fixation). Intravenous or mask anesthesia. The child is positioned supine. After locating the testicle in case of cryptorchidism, maximally isolating and ligating the vaginal process of the peritoneum without opening the inguinal canal, a tunnel is formed from the inguinal area with a finger or a gauze swab to the scrotum. A transverse incision of the scrotal skin equal to the maximum length of the testicle to be reduced is made along the skin fold in the lower third of the scrotum (1-2 cm from the root of the scrotum). A subcutaneous cavity for placing the testicle is formed with a clamp. The testicle is inserted into the scrotum, sutured with a nylon thread in the area of ​​the ligament of the tail of the epididymis, placed in a physiological position and fixed with a nylon thread to the dartos in the area of ​​the fundus of the scrotum and slightly medially.The scrotal inlet is then narrowed by placing two separate interrupted absorbable sutures at the level of the initial portion of the spermatic cord, immediately above the testicle and the head of the epididymis. The sutures also include the edge of the tunica testis (the remnant of the processus vaginalis, which contained the testicle). If the tunica testis (the processus vaginalis) is damaged during its removal, it is recommended to perform a tunica repair with a moderate narrowing at the level of the spermatic cord to match the diameter of the narrowed scrotal inlet to the tunica testis. The final step involves placing skin sutures on the scrotal and inguinal wounds.

[0007] The high efficiency of the claimed testicular fixation method is due to the following features:

[0008] Providing the testicle with a physiological position by fixing it at the lower pole to the fundus of the scrotum and slightly medially, as well as fixing the testicular tunics at the site of narrowing of the scrotal inlet to prevent excessive "lateralization" of the testicle while maintaining sufficient spermatic cord length. Preservation of the testicular tunics (the vaginal process around the testicle) and their anatomical position.

[0009] Effective narrowing of the scrotal inlet to prevent postoperative upward displacement of the testicle and recurrence. The absence of sutures in the area of ​​the created "tunnel" to the scrotum for the spermatic cord reduces the severity of the inflammatory process and the formation of coarse scars in this area, minimizing the risk of compression of the testicular vessels and vas deferens by scars and testicular nutritional impairment.

[0010] Good cosmetic effect - the scrotal skin suture is small and located on the undersurface, close to the scrotal root, making it completely invisible later, and the operated half of the scrotum appears almost symmetrical to the healthy half. A total of 146 children aged 8 months to 10 years have been operated on using this technique. There have been no recurrences. There was no testicular atrophy.

[0011] The method of testicular fixation is presented with a clinical example:

[0012] Patient X, a 1-year-old boy, was admitted to the Children's City Clinical Hospital No. 7 on a planned basis with a diagnosis of "left cryptorchidism and inguinal retention." The diagnosis was based on a clinical examination and ultrasound data: the left testicle had been in the inguinal region since birth, with no tendency to descend. The child underwent surgical treatment:

[0013] Mask anesthesia with sevoflurane. The child is positioned supine. An oblique transverse incision up to 2.5 cm long is made in the left inguinal region in the projection of the external inguinal ring (above the presumed palpable testicle). A testicle with signs of moderate hypoplasia is detected. The vaginal process of the peritoneum is isolated, maximally mobilized without opening the inguinal canal, ligated with a nylon thread at the neck, and cut off. Maximum mobilization of the spermatic cord is performed by transecting the levator muscle of the testicle and fascial bands - the length of the spermatic cord is sufficient to lower the testicle into the scrotum. A tunnel to the scrotum is formed from the inguinal region with a finger. A transverse incision of the scrotal skin up to 1.5 cm long is made along the skin fold in the lower third of the scrotum (1 cm from the root of the scrotum). A mosquito-type clamp is used to form a subcutaneous cavity for free placement of the testicle.The testicle is brought into the scrotum, sutured with nylon thread in the area of ​​the cauda epididymis ligament, placed in a physiological position, and secured with nylon thread to the dartos at the fundus and slightly medially. The entrance to the scrotum is reduced by placing two separate interrupted sutures (Surgicrol Rapid) that capture the edge of the preserved tunica vaginalis testis. Intradermal sutures are placed on the scrotal and inguinal wounds. Aseptic dressings are applied.

[0014] The boy was discharged on the second day after surgery. The patient was monitored for one year. Palpation and ultrasound revealed an increase in testicular volume within the normal range for age, and the position was normal. Cosmetically, the right and left halves of the scrotum appear identical, and the incision at the lower scrotum is not visible.

Claims

A method for fixing the testicle when lowering it into the scrotum, characterized in that a tunnel is formed from the inguinal region with a finger or a gauze swab to the scrotum, a transverse incision of the skin of the scrotum of the length of the maximum size of the testicle to be lowered is carried out along the skin fold in the lower third of the scrotum, retreating 1-2 cm from the root of the scrotum, a subcutaneous cavity is formed with a clamp for placing the testicle, then the testicle is passed into the scrotum, stitched with a nylon thread in the area of ​​​​the ligament of the tail of the epididymis, placed in a physiological position and fixed with a nylon thread to the fleshy membrane in the area of ​​​​the bottom of the scrotum, then the entrance to the scrotum is narrowed by applying two separate interrupted sutures made of absorbable material at the level of the initial section of the spermatic cord immediately above the testicle and the head of the epididymis with the capture of the edge of the membranes of the testicle, the remainder of the vaginal process, in which the testicle was located, then skin sutures are applied to the wound of the scrotum.

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