TRABUCCO HERNIA INSTITUTE
A. F. Trabucco,M.D.,F.A.C.S.
PRIMARY OFFIVE
For information contact:
325 Henry St.
North Vernon, IN 47265
(812)352-4476
Preshaped Sutureless Rigid Mesh Inguinal Hernioplasty
TRABUCCO HERNIA INSTITUTE
© TRABUCCO
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Local anesthesia
Subdermic and subcutaneous infiltration anesthesia. A transverse incision is made 1cm. below the deep inguinal ring.
Sub-fascial infiltration
An anesthetic solution is infiltrated under the external oblique aponeurosis.
Opening the roof of the inguinal canal
The external oblique aponeurosis is cut longitudinally
Division of the cremaster muscle
The cremaster muscle is grasped with two Allis clamps and divided longitudinally.It will be divided between the clamps. This allows for clear visualization of the spermatic chord components.
The mesentery of the spermatic cord
The spermatic cord is lifted, exposing its mesentery. A Kelly clamp is inserted at the base of the mesentery, under the neurovascular bundle. Care is taken to preserve the integrity of the ilioinguinal,genitofemoral and iliohypogastric nerves. The mesentery and spermatic cord are and encircled by a Penrose .
Exploration of the femoral canal
The inferior crus of the external oblique aponeurosis is dissected from the cribriform fascia to explore the femoral canal and to lengthen the crus. This is done to provide a “tension free” closure of the external oblique aponeurosis.
Plug T1
To see how The T1 plug is made by folding a soft round mesh into a dart shape press here.
Preshaped mesh and plug T4
Pre-shaped universal ,rigid or semi-rigid ,pre-shaped mesh 4.5 X. 10 centimeters. For male and female. Rigid plug T4
Dissection of an indirect sac
An indirect sac is dissected from the spermatic cord and the deep inguinal ring is exposed.
Placement of a plug T1
An indirect sac has been invaginated into the deep inguinal ring. A plug T1 is inserted into the ring and anchored with a suture.
Narrowing of the dilated deep inguinal ring is preffered in small indirect inguinal hernias. This is preferred in small hernias in the male and larger female hernia as opposed to insertion of the T1 Plug
Amputation of a sac
Plug T 4
To see the application of the T4Plug into the internal inguinal canal click here
Direct Hernia
The buldge of a direct hernia is flattened cosmetically with tension free continuous sutures.
Direct hernia with loss of posterior wall
A pre-peritoneal mesh is sutured without tension to the posterior wall defect. A pre-shaped mesh will be placed over the pre-peritoneal prosthesis.
Empty “inguinal box”
The floor of an inguinal canal after boat is of any hernia are flattened cosmetically. It is suggested to call the anatomical space shown in this illustration the “inguinal box”, to indicate the concept of a closed space.
Pre-shaped mesh in the inguinal box
The lateral mesh is tucked under the external oblique aponeurosis. A rigid pre-shaped universal mesh fits the entire inguinal box. The mesh cannot move or migrate, because it is placed in a closed anatomical space. It is not necessary to suture the mesh. To view the specifics of the technical aspects as well as closure of the aponeurosis click Here.
Closure of the aponeurosis
The aponeurosis of the extra oblique muscle is closed under the spermatic cord without tension, because the inferior crus has been widened during the exploration of the femoral canal
Rigid preshaped mesh
for a detailed description on the advantages of using a Rigid Preshaped mesh Press Here
Preshaped Mesh superimposed on the anterior abdominal wall
For more information and descriptions about recurrent hernias press here:
COPYRIGHT 1998
No part of this web site (booklet) may be reproduced without the written permission and consent of the author.
OTHER LINKS:
Medici Chirurghi:-Trattamento dell'ernia secondo il"Metodo Trabucco"
References:
05/18/03
