RU2311879C1 - Minimally invasive surgical method for treating abdominal wall defects - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves covering defect with cut hernial sack walls creating duplication. Circular synthetic polytetrafluoroethylene implant having 6 cm large diameter is rolled to form a tube. The implant is introduced into the abdominal cavity via trocar. The implant is caught with manipulators. The implant is stretched, placed over the duplication and fixed.

EFFECT: reduced risk of relapse and commissure formation.

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Description

The present invention relates to medicine, in particular to surgery, endoscopy, and for the surgical treatment of defects of the abdominal wall.

A known method of surgical treatment of umbilical hernia. After general anesthesia with muscle relaxation, the authors injected carbon dioxide into the abdominal cavity using a Veress needle, performed an audit of the abdominal cavity through a trocar and a laparoscope, after which the hernial sac was isolated by invagination into the abdominal cavity, and it was dissected circularly according to the defect of the abdominal wall of the parietal peritoneum and peritoneum exfoliated from the hernia gate, then the defect was closed with a mesh nickel-titanium implant, which was fixed with a hernial stapler, the peritoneum sheets were sutured with endosurgical sutures, and the puncture sheets on the skin side with interrupted sutures (authors - Radkevich A.A., Kuzmenko I.I., Gunter V.E. - 2004).

A significant disadvantage of this method is that when a hernial sac is isolated, it is dissected according to the defect of the abdominal wall, as a result, the peritoneal wall loses its strength, and when the peritoneal sheets are sutured, tissue tension is formed, which increases the likelihood of relapse. Due to the initial rigidity of the implant and its contact with the walls of the intestine, it is possible to injure their mesotolial surface, which contributes to the development of adhesive disease of the peritoneum. One of the disadvantages is the high cost of the material, which does not allow its use in everyday practice.

The technical result is the prevention of complications associated with relapse of hernias, the prevention of postoperative adhesions, the reduction of hospital stay, the reduction in the cost of the operation.

The proposed method is as follows. Under intubation anesthesia, trocar laparocentesis is performed. After the introduction of trocars and revision of the abdominal cavity organs, the hernia sac is excreted. After isolation of the hernial sac, it is invaginated into the abdominal cavity, an audit is performed, then its walls are dissected. The excess part of the bag is cut off, and the hernial defect is closed with the remaining walls, performing duplicate 1 without tensioning the tissues with endosurgical sutures. Then prepare a synthetic explant from polytetrafluoroethylene 2 in the form of a circle with a diameter of 6 cm, the explant is twisted into a tube to conduct it into the abdominal cavity through a trocar. Manipulators capture the explant, straighten it in the abdominal cavity, place it on top of the duplicate and fix it with a herniostapler to the abdominal wall.

The proposed method of treatment is illustrated by drawings

Clinical example. Patient K., 40 years old, (case history No. 27554/05), was admitted to the hospital with complaints of pain, protrusion in the umbilical region, correctable in the abdominal cavity, 4 × 5 cm in size. The disease was associated with lifting heavy loads. After examination and preoperative preparation, surgical intervention was performed. Under intubation anesthesia, trocar laparocentesis was performed. One trocar was located in the right hypochondrium, the second - in the left for manipulators, the third one was introduced with a laparoscope 4-5 cm above the navel. After the introduction of trocars and revision of the abdominal cavity organs, the hernia sac is excreted. After isolation of the hernial sac, it was invaginated into the abdominal cavity, an audit was performed, then its walls were dissected. The excess part of the bag was cut off, and the hernial defect was closed with the remaining walls, and duplicates were performed with endosurgical sutures. Then, a synthetic PTFE explant was prepared in the form of a circle of 6 cm diameter, the explant was twisted into a tube and passed into the abdominal cavity through a trocar. Manipulators captured the explant, straightened it in the abdominal cavity, placed it on top of the duplicate and fixed it with a herniostapler to the abdominal wall. In the postoperative period, the course is smooth, the patient was discharged on the 8th day after the operation.

The proposed method was used in a clinic in 9 patients with umbilical hernia. No complications using the method have been identified.

Thus, the results of clinical studies show that the proposed method increases the effectiveness of surgical treatment, prevents recurrence of hernia, prevents postoperative adhesions due to the porosity of the microstructure of the explant, its flexibility and infiltration by cells and tissues, and also reduces the length of hospital stay, making the operation available everyday practice.

Claims (1)

A method of surgical treatment of umbilical hernia, including general anesthesia, revision of the abdominal cavity through a trocar, isolation of the hernial sac by invagination into the abdominal cavity, its dissection, closure of the defect with an implant, which is fixed with a hernial stapler, characterized in that the defect is first closed with dissected walls of the hernial sac in the form duplicates, then a synthetic polytetrafluoroethylene implant in the form of a circle with a diameter of 6 cm is twisted into a tube, carried into the abdominal cavity through a trocar, capture ntat manipulators, straighten it, applied over dublication and fixed to the abdominal wall.