RU2314042C2 - Method for closing hernial defects and strengthening muscular-aponeurotic layer of anterior abdominal wall - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: the present innovation deals with closing hernial defects at hernias of anterior abdominal wall and strengthening muscular-aponeurotic layer at thinning the latter in case of suturing in laparotomic post-surgical wounds. At a distance against the edge and parallel to hernial defect one should implant a reticular belt into muscular-aponeurotic layer of anterior abdominal wall and direct the belt as stitches through muscular-aponeurotic layer with the help of a guide being a steel plate with a rounded and curved end and two transverse slots at opposite end for fixing the reticular belt mentioned. It is necessary to suture muscular-aponeurotic layer and reticular belt with ligatures. The innovation enables to decrease the mass of allomaterial and its implantation as reticular belt into muscular-aponeurotic layer of anterior abdominal wall is being an "interlayer" through which ligatures for closing hernial defect should be passed. This considerably decreases negative "sawing" impact of ligatures coming through aponeurosis.

EFFECT: higher efficiency.

3 ex

Description

The invention relates to surgery and can be, in particular, used to close hernial defects with hernias of the anterior abdominal wall and strengthen the muscular-aponeurotic layer during thinning of the latter when suturing laparotomic postoperative wounds.

According to various authors, the number of postoperative ventral hernias after laparotomy reaches 10-20%, and the recurrence of hernia repair and plastic surgery by local tissues reaches 30% (1). There is no ideal way to close hernial defects of the anterior abdominal wall. Therefore, there are many methods for closing hernial defects with local tissues, which are reduced to the creation of duplicate aponeurosis or the use of auto-, homotissues (hernial sac, skin, dura mater) (2). Currently, a more reliable and promising method is the use of allomaterials in the form of network fragments that are hemmed along the edge of the aponeurosis defect to the peritoneum, under the aponeurosis, or over the aponeurosis of the anterior abdominal wall (3).

The closest in the set of essential features is the method of closing hernial defects with a mesh fragment above the aponeurosis of the anterior abdominal wall, selected by the authors as a prototype.

The prototype method includes the isolation, opening and excision of the hernial sac, possibly suturing the peritoneum with the tissues of the hernial sac, suturing, if possible, of the whole or partial hernial defect with local tissues and closing the hernial defect with a mesh fragment (polypropylene, polysorb, nylon, lavsan) by hemming mesh fragment to the aponeurosis of the anterior abdominal wall. However, this method is not without drawbacks, the method described above involves the placement of a large mass of allomaterial covered with subcutaneous tissue and skin, which can cause rejection, seromas and suppuration. This may require further removal of this reticular fragment, which can lead to hernia recurrence.

Therefore, the objective of the invention is to reduce the risk of rejection, formation of seromas and suppuration by reducing the mass of allomaterial and implanting it in the form of a mesh tape into the muscular aponeurotic layer of the anterior abdominal wall.

The implanted mesh tape is a “gasket” through which the threads are passed to close the hernial defect, which reduces the negative “sawing” effect of the threads carried through the aponeurosis. This significantly reduces the number of rejections of the reticular fragment, the formation of seromas in the subcutaneous tissue, suppuration of the postoperative wound and the formation of ligature fistulas, recurrence of hernias. This is a new technical result.

The problem is achieved in that the method of closing hernial defects is characterized in that, retreating from the edge and parallel to the hernial defect, a mesh tape is implanted into the muscle-aponeurotic layer of the anterior abdominal wall, the tape is carried out in the form of stitches through the muscle-aponeurotic layer using a conductor, then stitched with threads muscle-aponeurotic layer.

The proposed method is as follows.

After excision of the hernial sac and closure of the peritoneum, the muscle-aponeurotic layer of the anterior abdominal wall is mobilized in the area of the hernial defect. After that, using a special conductor 1.5-2 cm from the edge of the hernial defect and parallel to the last, a mesh tape is implanted into the muscle-aponeurotic layer of the anterior abdominal wall 10 mm wide in the form of stitches 2-3 cm apart. The conductor is a steel plate with a rounded and bent end and two transverse slots at the opposite end to secure the mesh tape. Then the edges of the defect are stitched “edge to edge” with through threads that must pass through the mesh tape.

The mesh tape serves as the “matrix” on which scar tissue forms.

The implantation of the mesh tape into the edge of the hernial defect is impractical due to changes in it, the presence of a chronic infection, so the tape should be implanted into healthy tissues parallel to the hernial defect, 1.5-2 cm from the edge.

Holding the tape in the form of stitches through 2 cm is due to the bending of the conductor, allows you to reduce the ischemia of the tissues through which the tape is held, serves as a guide when passing the threads through the muscle-aponeurotic layer of the anterior abdominal wall.

Using a conductor allows you to do without an additional tool, reduce the time of surgery and minimize trauma to the tissues of the anterior abdominal wall during mesh tapes.

The implanted mesh tape is a “gasket” through which the threads are held to close the hernial defect and the reduction of the negative “sawing” effect of the threads carried through the aponeurosis.

Advantages of the technique:

1. The use of mesh tape can reduce the amount of implantable material, and consequently, reduce the likelihood of rejection of allomaterial.

2. The implantation of the mesh tape into the muscle-aponeurotic layer of the anterior abdominal wall allows reducing the number of postoperative complications in the form of accumulation of serous fluid under the skin and suppuration of the postoperative wound.

3. The implantable mesh tape serves as a “gasket” through which the threads are passed to close the hernial defect and reduces the “sawing” effect of the thread.

Here are extracts from case histories:

1. Mironova N.P. 64 years old, source No. 0405838, operated on in the 2nd surgical department of the Nizhny Novgorod Regional Hospital. N.A.Semashko 03/11/04 about a postoperative ventral hernia. Hernial defect 10 × 20 cm. Plastic hernia using mesh tape held in the form of a "spiral" through the edges of the hernial defect. The postoperative period without complications. Discharged 14 days after surgery.

2. Vinogradova M.I. 65 years old, source No. 0405866, operated on in the 2nd surgical department of the Nizhny Novgorod Regional Hospital. N.A.Semashko 03/11/04 about a postoperative ventral hernia. Hernial defect 8 × 16 cm. Plastic hernia using mesh tape, held in the form of "bows" through the edges of the hernial defect. The postoperative period without complications. Discharged 11 days after surgery.

3. Khabarova V.I. 61 years old No. 0502611, operated on in 1 surgical department of the Nizhny Novgorod Regional Hospital. N.A.Semashko 02.16.05 on the occasion of postoperative ventral hernia. Hernial defect 5 cm in diameter. Hernia repair using mesh tape held at the edges of the aponeurosis, then the aponeurosis defect is sutured with interrupted sutures with mesh capture. The postoperative period without complications.

Discharged 10 days after surgery.

In all cases, a conductor was used to conduct the mesh tape. In total, using the proposed method, 12 people were operated on. The results showed that there were no complications from the postoperative wound.

Information sources

1. A.D. Timoshin, A.V. Yurasov, A.L. Shestakov. "Surgical treatment of inguinal and postoperative hernias." M., Triad-X Publishing House, 2003.

2. Ibid., P.6.

3. Ibid., P.8.

4. Ibid., P. 65.

Claims (1)

A method for closing hernial defects and strengthening the muscular-aponeurotic layer of the anterior abdominal wall during thinning of the latter after laparotomy, including excising the hernial sac, closing the hernial defect using mesh material, characterized in that it departs from the edge and parallel to the hernial defect through the muscular-aponeurotic layer of the anterior abdominal the walls conduct a mesh tape in the form of stitches using a conductor representing a plate with a rounded and bent end and two transverse slots on the opposite end to secure the mesh belt, then the edge defect sewn threads passing through the screen belt.