RU2390309C1 - Plastic surgery of congenital defect of anterior abdominal wall in newborns - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to paediatric surgery, can be used in surgical treatment of malformations of anterior abdominal wall: gastroschisis, omphalocele. After eventrated organs are embedded in the abdominal cavity, a two-row purse-string suture is applied. At first, the musculo-aponeurotic nonabsorbable purse-string suture is applied at 0.2-0.3 cm from a defect edge. Then the cutaneous nonabsorbable purse-string suture is applied along the defect edge.

EFFECT: method ensures reducing surgical injures, provides uniform closure of wound edges and distribution of the eventrated organs in the abdominal cavity, and also presents an excellent cosmetic effect.

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Description

The present invention relates to medicine, in particular to pediatric surgery, and may find application in the surgical treatment of defects of the anterior abdominal wall (gastroschisis and omphalocele).

Gastroschisis and omphalocele occurs with a frequency of 1: 4000-6000 newborns.

Currently, many methods have been proposed for the treatment of defects of the anterior abdominal wall.

One of the methods of treating gastroschisis and omphalocele is radical primary plastic surgery of the anterior abdominal wall. The most famous and widely used is the method of layerwise longitudinal suturing of the anterior abdominal wall with interrupted sutures (Fig. 1) (SPRINGER SURGERY ATLAS SERIES. Editors: ISP Lumley, JR Siewert P., Puri., ME Hellwarth. Pediatric Surgery. (CHAPTER 16. Omphalocele Stig Somme, Jacob C. Langer.) (CHAPTER 17. Gastroschisis. Marshall Z. Schwartz.) P.153-170).

Also, with longitudinal plasty, the application of cruciform interrupted sutures is used (Fig. 2) (SPRINGER SURGERY ATLAS SERIES Editors: JSP Lumley., JR Siewert P., Puri., ME Hellwarth. Pediatric Surgery. (CHAPTER 16. Omphalocele. Stig Somme, Jacob C . Langer.) (CHAPTER 17. Gastroschisis. Marshall Z. Schwartz.) P.153-170).

For medium sized omphalocele, a continuous curl stitch is used (FIG. 3) (SPRINGER SURGERY ATLAS SERIES. Editors: JSP Lumley., JR Siewert P., Puri., ME Hellwarth. Pediatric Surgery. (CHAPTER 16. Omphalocele. Stig Somme, Jacob C . Langer.) (CHAPTER 17. Gastroschisis. Marshall Z. Schwartz.) P.153-170).

The disadvantages of these methods of plastics are:

- pronounced tension of the lateral surfaces of the abdominal wall (affects the increase in intra-abdominal pressure, increases the likelihood of failure of the joints),

- disfiguring postoperative scar, affecting the quality of life of the patient.

Another variety is the imposition of a transverse nodal suture for plastic abdominal wall (figure 4) (Karavaeva SA Workshop: "Diagnosis and treatment of surgical pathology in newborns. St. Petersburg March 12-22, 2007).

The disadvantages of the method are the formation of a scar and a high risk of asymmetry of the abdominal wall in the long term after maturation of the scar, which leads to a decrease in the quality of life of patients.

The objective of the invention is less traumatic, more physiological and aesthetic method of treating defects of the anterior abdominal wall.

This problem is solved by the method consisting in the fact that with gastroschisis and omphalocele of small and medium sizes, a double-row purse string suture is applied, which helps to reduce the invasiveness of surgical treatment, uniform reduction of the edges of the wound and distribution of eventual organs in the abdominal cavity, and also provides an excellent cosmetic result.

When viscero-abdominal imbalance (when the volume of evented organs does not correspond to the size of the abdominal cavity), manual stretching of the abdominal wall is performed (Fig.6). After complete immersion of the intestinal loops in the abdominal cavity (Fig. 8), a purse-string muscular-aponeurotic suture is applied with a non-absorbable suture material, retreating 0.2-0.3 cm from the edge of the defect. Then impose a purse string suture along the edge of the defect with non-absorbable suture material (Fig.9). First, the muscle-aponeurotic and then the skin purse string suture is tightened and tied.

Clinical example

A newborn girl, O., was born in 2004 by cesarean section in a 33-year-old mother with a body weight of 2700 g with an Apgar scale rating of 5-7 points.

This pregnancy is second, the first birth. In utero during ultrasound, it was found that the internal organs were evented, on the basis of which the diagnosis was made: a malformation of the anterior abdominal wall - gastroschisis. After birth, upon examination, the baby revealed a defect in the anterior abdominal wall measuring 3.0 × 3.0 cm, through which loops of the small and large intestines extend beyond the abdominal cavity (Fig. 5).

In the maternity room, along with the primary resuscitation measures, the child has a sterile dressing placed on the bowel loops that are previously immersed in a plastic container. After a short preoperative preparation, the child is taken to the operating room.

In connection with viscero-abdominal imbalance (the volume of evented organs did not correspond to the size of the abdominal cavity), manual stretching of the abdominal wall was performed (Fig.6).

Loops of the intestine are immersed in the abdominal cavity (Fig.7).

After complete immersion of the intestinal loops in the abdominal cavity, a purse-string muscular-aponeurotic suture with non-absorbable suture material (PDS 2/0) was applied, retreating 0.2-0.3 cm from the edge of the defect. After that, a purse-string skin suture was applied along the edge of the defect with non-absorbable suture material (PDS 4/0) (Fig. 8).

There were no complications during and after the operations. The results of abdominal wall plasty at discharge and 3 months after the operation showed a decrease in the invasiveness of surgical treatment, the absence of complications in the form of inconsistency of sutures in the postoperative period, and also provided an excellent cosmetic result, eliminating the need for repeated plastic surgeries in the future (Fig. 10).

Claims (1)

The method of plasticity for congenital malformations of the anterior abdominal wall in newborns, characterized in that after immersion of the eventual organs in the abdominal cavity, a two-row purse string suture is applied: first, a purse-string muscular-aponeurotic non-absorbable suture material, retreating 0.2-0.3 cm from the edge of the defect , then a purse-string skin suture along the edge of the defect with non-absorbable suture material.

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