In hernias containing bowel, intestinal obstruction occurs due to constricting deep and superficial inguinal rings
or in rare cases due to omental band within the hernial sac .
The presence of five veins at the deep inguinal ring
apart from other structures like vas deference, testicular artery and the lymphatics might hinder the venous drainage of the testis and thus result in varicocele.
Purse string taken around the deep inguinal ring
by taking small bites of peritoneum.
The primary 5 mm camera port was introduced by open technique (inferior rim of the umbilicus on its internal surface), pneumoperitoneum was created (10mmHg) with the patient in a 30[degrees] head-down Trendelenburg position, the area of the internal inguinal ring
was inspected bilaterally, and subsequent trocars (all 5 mm) were placed under laparoscopic (30[degrees] telescope) visualization into the right and left lumbar region in line with the umbilical port.
Doppler ultrasonography of the scrotum revealed a hematoma extending from the left superficial inguinal ring
to the left hemiscrotum, partially surrounding the left testis.
We then used a modified Stoppa technique by placing the 6 x 6 in Prolene mesh under the damaged internal inguinal ring
, making sure the spermatic cord on the left side was not injured or pinched, securing it in place using sutures, including direct suturing to the periosteum of the repaired pubic symphysis and the plate as needed.
Mechanical venous obstruction occurs owing to a compressed cord by a hernia, leading to the swelling of the cord from the internal inguinal ring
outward toward the testis.
In addition, the processus vaginalis, an evagination of the parietal peritoneum, elongates through the internal inguinal ring
between the internal and external oblique muscles, creating a path for the descending testis to reach the scrotum.
SUMMARY--The bilayer patch device (Ethicon, Prolen Hernia System[R]) for inguinal hernia repair has a connector that acts as a ,plug' in the internal inguinal ring
. The position of this ,plug' component may be responsible for higher incidence of chronic pain and intestinal damage.
Neece, prefer to start near the bladder, by the inguinal ring
. "In my experience, I have found more abdominally retained testicles further down in the abdomen," she says.
The first half of the circle was begun extraperitoneally from the anterior edge to the posterior edge around the internal inguinal ring
. When half of the circle was accomplished, the peritoneal cavity [Figure 2]b was punctured and the end of the 2[sup]# thread into the peritoneal cavity was pulled using a grasper [Figure 2]c.
The laparoscopic approach enables occlusion of the internal inguinal ring
(MARIEN, 2001; BOENING et al., 2007; CARON & BRAKENHOFF, 2008; WILDERJANS et al., 2009) and can be used to prevent recurrences following emergency surgical intervention.