RU2328991C1 - Method of diastases recti abdominis treatment - Google Patents

Abstract

FIELD: medicine; surgery.

SUBSTANCE: prosthesis is used as rectangular plate of width 6-10 cm supplied with fixing tapes of width 2-2.5 cm, located in spacing 3-4 cm from each other by both sides along the full length corresponding to diastases extension. Release and opening of sheath leaves of both abdominal recti by their internal edges and closure posterior sheath leaves, they are filed with plate. Fixing tapes are inserted under aponeurosis of abdominal recti sheath. Abdominal recti are clasped with them. They are combined in median position and tapes are fixed on plate, anterior abdominal recti sheath leaves are closed with wound layered closure.

EFFECT: method enables to hold reliably abdominal recti with reduction trauma number.

2 cl, 2 dwg, 2 ex

Description

The invention relates to medicine, namely to surgery, and can be used in the treatment of diastasis of the rectus abdominis muscles.

As a rule, median ventral hernias are accompanied by diastasis of the rectus abdominis muscles. Often, diastasis of the rectus abdominis also occurs as an independent disease. In both cases, the known methods are not always effective enough.

It is known that “bandaging” with polypropylene tapes is suggested to retain the rectus abdominis muscles (Kubo G, Rose J. Rectusbanding by polypropylene-mesh-a new method for incisional hernia repair Zentralbl Chir. 2002 Jul; 127 (7): 583-8) . The latter, 2 cm wide, is inserted under the aponeurosis of the vagina of the rectus abdominis muscles and encompasses the muscles on both sides. The distance between the tapes is approximately 2 cm. The front and back sheets of the rectus sheaths are sutured with a continuous suture.

The method has its drawbacks. Ribbons 2 cm wide under the influence of the wrinkling effect can decrease by 2/3 of their original size and turn into cords, which makes the method traumatic and not reliable enough to hold the rectus abdominis muscles.

Currently, the treatment of diastasis of the rectus abdominis muscles with median ventral hernias is often carried out using the Rives Stoppa method (Bauer JJ, Harris MT, Gorfine SR, Kreel I. Rives-Stoppa procedure for repair of large indsional hernias: experience with 57 patients. Hernia. 2002 Sep ; 6 (3): 120-3). After opening, excision of the excess and suturing of the hernial sac open the vagina of the rectus abdominis muscles at their inner edges. The back leaves of the vagina are separated from the muscles to their lateral edges and sutured with a continuous suture. On the stitched back leaves of the vagina, a mesh implant is laid and hemmed. Then the aponeuroses of the anterior vaginal sheets of the rectus abdominis are sutured. This method is accepted by the authors as a prototype.

The disadvantage of the prototype is the following. Since only aponeurosis leaves are subject to stitching, using this method it is not always possible to eliminate diastasis of the rectus abdominis muscles. Under the influence of high intra-abdominal pressure, the muscles often diverge and diastasis recurs.

The technical result of the invention is to increase the reliability of retention of the rectus abdominis muscles and reduce their trauma.

The specified technical result is achieved by the fact that in the known method of treating diastasis of the rectus abdominis muscles, including the extraction and opening of leaves of the vaginas of both rectus abdominis muscles at their inner edges, suturing the posterior leaves of the vaginas, suturing to them a mesh prosthesis, according to the invention, the prosthesis is in the form of a rectangular plate with a width 6-10 cm, equipped with fixing tapes 2-2.5 cm wide, evenly spaced 3-4 cm apart from each other on both sides of the plate along its entire length corresponding to the length of the diastasis they are sutured along the midline of the plate parallel to its length, and then the fixing tapes are inserted under the aponeurosis of the vagina of the rectus muscles, grasp the rectus muscles by them, bring them into the middle position and fix the tapes on the plate along the previously applied sutures, suture the front leaves of the vagina of the rectus abdominis muscles and in layers sutured the wound.

It is advisable in case of median ventral hernias accompanied by diastasis of the rectus abdominis muscles, after the stages of isolation of the hernial sac, its opening, reduction of the hernial contents and suturing of the peritoneum to carry out the treatment of diastasis of the rectus abdominis muscles as described above.

New in the invention is the use of the prosthesis of its original form.

The inventive step is confirmed by the achievement of a new technical result due to the new form of the prosthesis.

The non-obviousness of the result was confirmed by clinical trials. Studies have shown that fixing the tapes on the plate prevents them from twisting into cords over time and allows you to hold the rectus muscles using fewer tapes, which reduces trauma to the rectus muscles. Thus, in comparison with the well-known “bandaging” with polypropylene tapes, a new technical result is achieved. At the same time, the presence of tapes makes it possible to reduce the width of the plate of the prosthesis used in comparison with the prototype, while the reliability of the plastic is guaranteed by the reduction of rectus muscles by tapes. In addition, with large hernial gates of the median ventral hernias, one more technical result is achieved: this method allows the prosthesis to be covered with the reduced straight muscles even without stitching the aponeurosis and thus prevent the polypropylene mesh from contacting the subcutaneous tissue.

The essence of the method is illustrated by graphical images of the stages of the method for the treatment of diastasis of the rectus abdominis muscles in figures 1, 2,

figure 1 presents the stage of application and hemming of the prosthesis on the posterior sheets of the vagina of the rectus abdominis muscles;

figure 2 presents the step of suturing the front sheets of the vagina of the rectus abdominis muscles.

The method can be carried out as follows.

In the presence of a median ventral hernia, secrete, open, dissect the excess and suture the hernial sac. If there is only diastasis of the rectus muscles of 1 abdomen without a hernia, this stage of the operation is absent. Allocate and open at the inner edges of the leaves of the vagina of the rectus 1 muscles of the abdomen. The back sheets 2 of the rectus sheaths 1 of the abdomen are sutured with nodal sutures 3. A prosthesis is made of a polypropylene mesh, which is a rectangular plate 4 with fixing tapes 5 located on both sides of the plate 4 along its length. The length of the plate 4 corresponds to the length of the diastasis of the rectus 1 muscles of the abdomen and necessarily overlaps the upper and lower border of the sutured hernial collar by at least 5 cm. The width of the plate 4 is 6-10 cm and 3-5 cm overlaps the suture line of 3 sutured posterior sheets of 2 aponeurosis rectus sheaths 1 abdomen. The width of the cut out tapes 5 is 2-2.5 cm, and their length is determined so that they can freely grasp the rectus muscle 1 of the abdomen. The distance between the tapes 5 is 3-4 cm, and their number on each side of the plate 4 depends on its length. The prosthesis is placed on the posterior sheets 2 of the rectus sheaths 1, orienting the rectangular plate 4 along the entire length of the diastasis and fixing it along the midline to the previously applied sutures 3 of the posterior sheets of the 2 rectus sheaths 1. Sometimes, the prosthesis is also hemmed along the perimeter of the plate with 4 interrupted sutures to the back sheets 2 of the sheaths of the rectus muscles 1. Then, with the ribbons 5, they encircle both rectus muscles 1 under the aponeurosis, stitch the ends of the ribbons with 5 suture threads 3, fixing the rectangular plate 4, and tie the threads. Active drainage is established. The anterior sheets 6 of the rectus sheaths are sutured 1. The wound is sutured in layers and another active drainage is established in the subcutaneous tissue.

The method is illustrated by the following clinical examples.

Example 1. Patient G., 53 years old, was hospitalized for diastasis of the rectus abdominis muscles and umbilical hernia. During the examination, against the background of severe obesity, the presence of diastasis of the rectus abdominis muscles by 8 cm and a small umbilical hernia (2 cm). 12/15/05. operation performed. Two bordering sections dissected excess skin and subcutaneous tissue. The umbilical hernia is corrected without opening the hernial sac. The vagina of the rectus abdominis was opened at their medial edges. The back leaves of the vagina of the rectus abdominis muscles are sewn with interrupted sutures, to which a polypropylene mesh is fixed in the form of a rectangular plate 10 cm wide with six fixing tapes located along the plate at a distance of 3 cm from each other - three on each side. The length of the plate overlaps the upper and lower borders of the sutured hernia gate by at least 5 cm. The plate is hemmed to previously applied interrupted sutures along its long axis, and fixing tapes 2 cm wide after being held around the rectus abdominis muscles are fixed on the plate using the ends of the interrupted sutures. . Active PVC drainage is located under the sutured anterior leaf of the vagina of the rectus abdominis muscles. The postoperative course is smooth. The patient was discharged 8 days after surgery. Currently, the patient is in good health, no complaints. The physical activity is not limited, there is no relapse of the disease.

2. Example 2. Patient G., 70 years old, was hospitalized for diastasis of the rectus abdominis muscles with a length of 6 cm. An operation was performed on 01/18/06. The vagina of the rectus abdominis was opened, and a prosthesis made of polypropylene mesh in the form of a rectangular plate with a width of 8 cm with four side tapes (2 on each side) that grasped and pulled both rectus muscles was fixed on the back sheets that were sutured. The width of the tapes is 2.5 cm, the distance between them is 4 cm. The length of the plate overlaps the upper and lower borders of the sutured hernia gate by at least 5 cm. Above the flattened muscles, the front sheets of the vagina of the rectus abdominis are sutured. The postoperative course is smooth. The patient was discharged on the 9th day after the operation. The wound healed by primary intention. Currently, she is feeling well, she is doing physical work, and there is no relapse of the disease.

The proposed method carried out 10 operations. Of these, 7 operations were performed for a median ventral hernia accompanied by diastasis of the rectus abdominis muscles, and 3 operations for plastic surgery of the rectus diastasis of the abdominal muscles without a hernia.

The proposed method has the following advantages.

1. Reduction and reliable retention in the mid-position of the rectus abdominis muscles. Thereby reliably eliminated diastasis of the rectus abdominis muscles.

2. The reliability of hernioplasty of the median ventral hernias is increased.

3. The method can be used both independently and as an auxiliary technique in the treatment of giant ventral hernias.

4. Provides the best conditions for the engraftment of the prosthesis.

5. Simplicity and safety of prosthesis fixation.

6. Reduction of operation time.

7. Technical simplicity.

Claims (2)

1. A method of treating diastasis of the rectus abdominis muscles, including the isolation and opening of leaves of the vaginas of both rectus abdominis muscles at their inner edges, suturing the posterior leaves of the vaginas, suturing a mesh prosthesis to them, characterized in that they use a prosthesis in the form of a rectangular plate 6-10 cm wide equipped with fixing tapes 2-2.5 cm wide, evenly spaced 3-4 cm apart on both sides of the plate along its entire length, corresponding to the length of the diastasis, the prosthesis is placed directly on the stitched back sheets of the vagina muscles, fix it along the midline to the previously applied sutures of the posterior sheets of the vagina of the rectus muscles, then grasp the rectus muscles with ribbons, bring them to the middle position and fix the tapes on the plate to the previously applied sutures, suture the front sheets of the vagina of the rectus abdominis muscles and suture the wound in layers . 2. The method according to claim 1, characterized in that with median ventral hernias accompanied by diastasis of the rectus abdominis muscles, the treatment is performed after the stages of isolation of the hernial sac, its opening, reduction of the hernial contents and suturing of the peritoneum.

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