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hernia surgical repair of a huge revolution. The medical history of the earliest recorded inguinal hernia is 1124-1151 years BC, the Egyptian mummy of Ramses V with a clearly defined inguinal hernia, Alexander era of hernia belt, and Hippocrates described in the differential diagnosis of a hernia and scrotal effusion. 200 AD, Galen proposed hernia is associated with the fascia and muscle extension peritoneal rupture formed, Guy de Chauliac in 1363 first described the difference between femoral hernia and inguinal hernia. Renaissance period, the anatomy of the founders of Benivieni carefully documented clinical data, follow-up and autopsy of his patients, to document and describe the various types of hernia, and later scholars the Ambroise proposed hernia contents should suture the peritoneum is also satisfied, while condemning the The Youyi castrated surgery method. After the Renaissance, Pott, Richter, Camper, Scarpa and Morton hernia and abdominal wall structure named as Gimbernat ligament, Camper fascia, cooper ligament, Hesselbach triangle, Scarpa fascia, Richter hernia, etc.. Based on the above knowledge of anatomy, in 1876, published by the American Greensville Dowell famous monograph about hernia radical mastectomy papers, 1871 Marcy first use of the three principles of hernia surgery: sterile technique, high ligation tightening within ring. Bassini's operation to create a new era of hernia surgery, through the analysis of a variety of reasons for the failure to give up the the deep suture inguinal canal, high ligation of the hernia sac, the joint tendon, abdominal oblique and transverse fascia sutured to the inguinal ligament, reconstruction groin physiology, he carried out a series of follow-up, mortality, and the infection rate is still quite low. Halsted founded another technique, different spermatic cord to the top of the external oblique. The Georg Lotheissen use of Cooper ligament hernia repair. 1956 the surgical anatomist Fruchaund inguinal hernia the pubic muscle mouth and the transverse fascia tunnel concept. Shouldice and other development Bassini technique, focusing on transverse fascia repair, so far is still the most effective hernia repair. As materials science, anatomy, development of laparoscopic surgery in the 1990s, hernia repair into a tension-free and laparoscopic surgical era. Lichtenstein first proposed a \. In 1982, Ger first reported the first laparoscopic inguinal hernia repair, using Michel folder Close sac neck [3]. ,Common surgical laparoscopic hernia treatment of adult laparoscopic ways peritoneal the previous patch implantation (transabdominal preperitoneal prosthetic, TAPP), completely peritoneal outer patch repair (totally extraperitoneal prosthetic TEP) and intra-abdominal mesh repair (intraperitoneal onlay mesh, IPOM), although the exact effect, but the first two operations are complex, dissecting range, longer operative time, IPOM after patch, nail clip direct contact with intra-abdominal bowel, leading to surgery The main reason of the serious complications after intestinal adhesions, intestinal perforation and infection abscess [8]. Intraoperative blind nail clip, may damage the iliac vessels, may also damage nerves, leading to postoperative groin sensation, numbness, pain, discomfort, and even the neuroma [9,10]. To reduce intraoperative and postoperative complications, and the pursuit of less trauma, we propose the use of umbilical the medial plica patch inguinal hernia, and improved laparoscopic completely built-in patch repair peritoneum of the abdominal cavity, and animal experiments, carried out the surgical anatomy as well as clinical research, built-in patch surgery (total peritoneum intraperitoneal onlay mesh, TPIPOM) provide the basis of accurate clinical application is laparoscopic totally peritoneum of the abdominal cavity. In this study, as part of the subject, and will focus on the introduction and the surgical groin area, umbilical the medial plica anatomy and clinical effect. Chapter groin area anatomical study Objective To study the groin area and the inner ring surrounding local anatomical features built-in patch repair (TPIPOM)) provide accurate clinical applied anatomy for laparoscopic completely peritoneal abdominal cavity. Method the bodies of 18 men and 11 women, seven of 36 side. Anatomy of the groin area and inner ring surrounding structure, observed ilioinguinal nerve (the ilioinguinal nerve IGN), iliohypogastric nerves (iliohypogastric nerve, IHN) in the groin area to mark two nerve through the abdominal anterolateral wall three flat muscle location accuracy of 0.5mm steel ruler measuring the distance of two nerve clothed muscle point to the corresponding bony landmarks points: to wear abdominal oblique (to the anterior superior iliac spine), wear external oblique (from the pubic symphysis edge), wear abdominal external oblique muscle (from the pubic tubercle), as well as the distance between the IGN, IHN, were recorded as Lh1, Lh2 Lh3 Lg1 Lg2 Lg3 L4; find the spermatic cord, spermatic cord arteriovenous iliac Outside arteriovenous obturator artery and vein and the relationship between the relevant bony landmarks. Since the abdominal cavity inside of turn open abdominal anterolateral wall layers, first remove the internal ring center diameter of about 10cm parietal peritoneum, the anatomy of the spermatic cord, vas deferens, spermatic vessels (round ligament of the uterus), external iliac vessels, abdominal The vascular, reproductive femoral nerve, femoral nerve, lateral femoral cutaneous nerve structure, measuring the distance with bony landmarks, measure the Triangle of Death and pain triangular angle between the application of 3D image processing software to establish the the male inner ring surrounding local anatomical model. Lower abdomen from the midline abdominal full-thickness incision significantly lo shi medial plica and measure its length and width, open peritoneal observe whether extraperitoneal important nerves, blood vessels from the inside the navel medial plica. Application SPSS13.0 software statistics, measurement data (mean ± standard deviation) Description. Results iliohypogastric nerve anterior superior iliac spine, medial (4.09 ± 0.33) cm at crossing the abdominal oblique muscle from the pubic joint on the edge (5.02 ± 055) cm through the external oblique fascia at; ilioinguinal nerve iliac the inside of the spine (3.00 ± 0.43) cm at through the abdominal oblique, pubic tubercle above the upper edge from the pubic symphysis (3.87 ± 0.45) cm at through the external oblique aponeurosis. Spermatic cord, vas deferens, spermatic vessels, the external iliac vessels, abdominal vascular, reproductive femoral nerve, femoral nerve, reproductive femoral nerve, lateral femoral cutaneous nerve in the inner ring surrounding two important areas: Triangle of Death and pain Triangle; Triangle of Death: vas deferens, testicular artery and vein were within the outside edge, both in the internal ring cross into the angle, the average (48.8 ± 3.7) °; pain Triangle: the outside of the Triangle of Death, testicular artery and vein and groin ligament, respectively, for the inside and outside edges of the region deep surface of the lateral femoral cutaneous nerve and reproductive femoral nerve through, the average angle between approximately (21.0 ± 4.0) °. Conclusion quantified by measuring the vital structures of the groin area and the establishment of the inner ring surrounding local anatomical model of reducing TPIPOM intraoperative and postoperative complications can provide important reference value. The second chapter of the umbilical medial plica anatomical study purposes through the umbilical medial plica anatomy, built-in patch repair abdominal cavity for laparoscopic completely peritoneal provide accurate anatomical basis of clinical application. Method autopsy group (A): along the lower abdomen rectus next cut the skin, subcutaneous tissue, the anatomy of the groin area muscularis revealed the ilioinguinal nerve, iliohypogastric nerves, spermatic cord structure; from the internal ring the peritoneum open fully free the peritoneum, significantly hilum the medial plica well as the inner ring surrounding anatomical structures, control laparoscopic living donor anatomy. Laparoscopic surgery were divided into group B (hernia repair group) and Group C (non-hernia repair group), with homemade with scale (0.5mm) diameter 2mm sterile infusion tube by the Torcark placed in the abdominal cavity, inside measurement bilateral umbilical plica of pneumoperitoneum state thickness (T1, Tr), the width (D1, Dr); the free positive the incision group B outside of the umbilical medial plica peritoneal inwardly midline downwardly free to the pubic symphysis or less reaches the basin wall above, observed in vivo umbilical the medial plica surrounding extraperitoneal structure; SPSS13.0 analysis, measurement data with the two-sample t test, p lt; 0.05 the difference was statistically significant. Results cadavers parietal peritoneum and folds atrophy, soaked in formalin solution outside the addition to atresia umbilical artery umbilical medial plica, found no obvious blood vessels and nerves through the region; B group laparoscopic: Umbilical medial plica is fully free, umbilical medial plica median umbilical fold and pubic triangle area found no nerves and blood vessels by a small number of cases can be found variation Vice obturator vessels, no significant active bleeding after free have sufficient free area covered by the patch. B, C two sets all in vivo umbilical the medial plica able observed thickness of 3.03 ± 0.29mm, width of 9.98 ± 1.52mm, the bilateral umbilical medial plica and lateral umbilical folds highly symmetric; B, C group the bilateral umbilical medial fold thickness, width comparison, P were greater than 0.05, the difference was not statistically significant; different ages (18-50 years old, 50 years old or more) the bilateral umbilical medial plica width, thickness comparison, P greater than 0.05, the difference was not statistically significant. Conclusion umbilical medial plica in TPIOPM surgery can be completely covered by the patch, the procedure has safety, reliability, minimally invasive advantages. The third chapter laparoscopic completely built-in patch repair clinical application purpose of assessment of laparoscopic completely built-in security patch repair as well as the superiority of the peritoneum of the abdominal cavity peritoneum of the abdominal cavity. Method study group (A) 30 cases, including 24 males and 6 females, average age 44.77 ± 13.77 years, line TPIPOM surgery; 30 cases of group B of the control group, including 28 males and 2 females, mean age 49.60 ± 13.94 years old, line TEP procedure. Assessment of two groups of surgical time, bed time, postoperative complications, length of hospital stay, cost, and recurrence rate indicators. Results Group A laparoscopic complete: 29.77 ± 0.87 minutes operative time, intraoperative blood loss was 3.39 ± 0.23ml, bed time hour hospital stay time of 33.83 ± 0.74 3.16 ± 0.13 days, recovery of gastrointestinal function 15.23 ± 0.72 hours number of patients using painkillers after two cases, the cost of $ 8358.90 ± 103.31, the postoperative seroma no scrotum; over the 1-year follow-up, chronic pain in the groin area, showed no recurrence. Group B had no transit: 53.30.5 ± 1.71 minutes operative time, intraoperative blood loss was 56.80 ± 1.79ml, get out of bed hour hospital stay time of 34.37 ± 0.83 3.22 ± 0.17 days, gastrointestinal function recovery time of 15.64 ± 0.65 hours, intraoperative The number of patients using painkillers after nine cases, cost $ 8412.40 ± 70.41, postoperative scrotal seroma seven cases; over the 1-year follow-up, six cases of chronic pain in the groin area, recurrence; research group operative time, blood loss, average out of bed activity time, average length of stay and the number of postoperative analgesia, postoperative chronic pain rate than the control group, P lt; 0.05, the difference was statistically significant. Conclusion TPIOPM compared with TEP, the same safe, reliable and advantages, and smaller wounds.
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