RU1801376C - Method for treatment of large ventral hernias - Google Patents

Abstract

Usage: in the treatment of large ventral hernias. SUMMARY OF THE INVENTION: after hernia repair, polymer material is sutured from the compoplast container to the edges of the hernia gate and removed on day 17-20 after its aseptic sequestration, which allows temporary closure of the anterior abdominal wall defect.

Description

The invention relates to medicine, namely to emergency surgery, and can be used to temporarily close an extensive abdominal wall defect.

It is an object of the invention to temporarily close an abdominal wall defect during an emergency operation.

Treatment of patients by the claimed method is carried out as follows.

Excision of old postoperative scars is performed along with altered skin and subcutaneous tissue. A hernial sac is isolated, opened and dissected. Its contents are pushed into the abdominal cavity. Alloplasty of the anterior abdominal wall is performed using the compoplast container material as an allograft. The compoplast container is part of a one-time transfusion system, made in the form of a bag measuring 20x15 cm and placed in a sterile package. With aseptic compliance, a flap corresponding to a hernia defect is cut out of the container bag. The edges of the flap are sutured to the edges of the hernia gate with nodal kapron or lavsan sutures. After 2 contrapertures on the skin of the abdomen, 2-4 drainage tubes are passed into the wound,

which stack over compoplasts. Nodular sutures are applied to the skin edges of the wound. The drainage tubes are removed after 3-5 days.

After 17-20 days from the moment of surgery, a fluctuation is determined under the skin, which indicates aseptic sequestration of the compoplast. The skin edges are diluted under intravenous anesthesia, while tissue fluid that has accumulated around the compoplast is aspirated. The interrupted sutures with which the compoplast was sutured to the edges of the hernia gate were removed, and the compoplast was removed. Above the granulation tissue formed under the compoplast, the skin edges of the wound are sutured with interrupted sutures.

For example Sick A., 72 years old, was admitted to the hospital with a diagnosis of Postoperative ventral hernia.

During hospitalization, complaints of cramping abdominal pain, vomiting of gastric contents, shortness of breath, pain in the heart.

From the anamnesis, it was found that 30 years ago, the patient developed shortness of breath and pain in the region of the heart, which intensified after eating. The examination revealed the presence of stenoel

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cardia of tension, atrial fibrillation. X-ray revealed a mediastinal cyst on the left, with a diameter of up to 14 cm.

Over the following years, the patient was systematically treated for cardiopulmonary insufficiency.

She was operated on for a restrained umbilical hernia, however, after six months hernia recurred, she was subsequently operated on five times for a restrained recurrent hernia. After each operation, relapse soon occurred due to abdominal tension in patients with epigastric pain. areas worse after eating.

Upon admission to the clinic, the general condition of the patient is severe. Shortness of breath at rest up to 32 breaths per min. Arrhythmic pulse 90 beats in 1 mi, blood pressure 140/90 mm Hg

On the front wall of the abdomen there are many postoperative scars of irregular shape. Here, a hernial protrusion of 40x40 cm, under the skin of which peristaltic intestinal loops are contoured.

The hernial protrusion is mild, but its finger is accompanied by increased pain in the abdomen. Symptoms of peritoneal irritation are negative, and an increase in peristaltic murmurs is determined auscultatively throughout the abdomen.

On a survey radiograph of the abdominal organs, Kloiber bowls were found.

With fibrogastroscopy in the lumen of the stomach, mucus. The gastric mucosa is edematous, the exit section is deformed with a pronounced inflection, and therefore it was not possible to enter the lumen of the duodenum. All this is explained by the presence of adhesions in the abdominal cavity.

The diagnosis was made: Adhesive intestinal obstruction and the patient was offered surgical treatment. Two semi-oval incisions bordering the old postoperative scars excised the skin and subcutaneous adipose tissue. A hernial sac was isolated and opened, the contents of which were swollen loops of the small intestine. Single adhesions between the loops of the intestine and the walls of the hernial sac were dissected, after which it was relatively free to enter the abdominal cavity through the huge hernial gates. Exudation in the abdominal cavity, no. As a result of the audit of the abdominal cavity, it was found that there is a restrained diaphragmatic parasternal hernia on the left. The transverse intestine, loops of the initial part of the small intestine, large omentum and entral stomach were removed from the hernial sac. Extracted

bodies did not have a strangulation furrow and are quite viable ..

The hernia gate of the diaphragmatic hernia is sutured with mylar sutures by stitching the diaphragm to the costal arch.

The closure of the hernial portal of the anterior abdominal wall was not possible, since their size was 30x18 cm. Almost the entire intestine and omentum were outside the abdominal cavity. The omentum was removed. Plastic of the anterior abdominal wall was made with two stitched compoplasts, the edges of which are hemmed to the edges of the hernial portal with interrupted dacron sutures. Through contrapertures on the skin of the abdomen, 4 drainage tubes were placed in the wound, which were laid over the compoplasts. Suturing of the skin edges of the wound with interrupted sutures.

The postoperative course is severe, however, as a result of intensive therapy, the patient's condition progressively improved.

On the 20th day after the operation, fluctuations appeared under the skin around the postoperative scar, which is regarded as a sign of sequestration of compoplasts. Under intravenous anesthesia, the skin edges of the wounds were diluted, about 50 ml of straw-yellow clear liquid accumulated over the compoplasts. Snapped nodal sutures and compoplasts were removed. Under them a granulation tissue was formed, which completely covered intestinal loops. Nodal sutures on the skin. On day 10, the sutures were removed and the patient was discharged in satisfactory condition.

Control inspection after 1 year. The general condition of the patient is good, does not present any complaints. Heartbeats are rhythmic. Pulse of satisfactory qualities 72 beats in 1 min, rhythmic ..

Blood pressure 140/80 mm Hg The abdomen is soft, painless. There is a postoperative scar on the skin of the anterior abdominal wall; there is no hernial extrusion. An X-ray examination of the lungs, heart, and gastrointestinal tract revealed no pathological changes. The patient is active, there is no shortness of breath, freely rises to the 2nd floor.

The advantages of the claimed method lies in the fact that the method allows to produce temporary adequate alloplasty with a compoplast of the anterior abdominal wall in emergency conditions with large postoperative ventral hernias. The compoplast is in a sterile package and can be used immediately without additional sterilization. Compoplast, an aseptic irritant, promotes rapid growth of granulation tissue, which reliably closes the defect in the anterior abdominal wall. Having a continuous smooth surface, the compoplast does not sprout with granulation tissue, but being a foreign body, undergoes aseptic sequestration by the time of reliable closure of the anterior abdominal wall defect by granulation tissue.

The claimed method is the only one that allows these severe patients under emergency surgery to repair a large defect in the anterior abdominal wall using available alloplasty agents.

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The preclinical trials of the claimed method were performed in 2 patients. All patients recovered.

FORMULA-ZOBRETEN

A method of treating large ventral hernias, including herniation, suturing of a polymer explant with a size corresponding to an anterior abdominal wall defect to the edges of the hernial portal, suturing of the skin above it, characterized in that, in order to temporarily close the defect, an explant is used Compoplast container material and removed on day 17-20.