RU2410044C1 - Method of internal abdominal hernia repair - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: vascular pedicle graft consisting of left gastroepiploic artery and vein is formed. A left colic flexure is mobilised. A left colic flexure is mobilised. An avascular region of a mesentery of the left colic flexure is holed. An epiploic graft is delivered in a mesentric window and lowered within a small pelvis. A prolene mesh of the area equal to half-width of the graft is laid on said width of the graft. The prolene mesh is angularly fixed to the graft by separate interrupted sutures, a mesh edge is spaced upwards towards the vascular pedicle at a distance of half-width of the mesh, and the vascular pedicle is fixed at said distance to the middle of the mesh by separate sutures. Free edges of an epiploon are sutured over the mesh, the edges of the mesh and epiploic graft are underrun.

EFFECT: method allows to separate the prolene mesh from abdominal cavity organs and wound cavity tissues, and to prevent development of decubitus ulcers of the prolene mesh in large and small intestinal loops, fistulas, suppuration and rejection of the mesh.

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Description

The invention relates to medicine, mainly to oncology, and may find application in the treatment of patients with malignant tumors of the pelvic organs.

A known method of hernia repair, which consists in using a skin autoimplant (V.P. Rekhachev, Ya.A. Nasonov, E.A. Petukhov "Application of a skin autoimplant as an operation of choice for postoperative ventral hernias" (Arkhangelsk), Topical issues of herniology " Moscow, November 9-10, 2002, p. 51). The method has significant disadvantages. In the clinic, using a skin autoimplant, flap necrosis is not uncommon, leading to a relapse of hernias.

As a prototype, the method of plasticity of the hernial opening of the prolene mesh was selected, when the prolene mesh was located between the subcutaneous fat and the sheet of peritoneum, or fixed between the sheets of aponeurosis and peritoneum. (“Hernia repair using a synthetic mesh” by T.A. Chartolani, G.V. Pipia, D.T. Abuladze, M. M. Kiladze, J. P. Pkhaladze, T. I. Imnadze. (Tbilisi). "Actual issues of herniology" Moscow, November 9-10, 2002, p. 71).

The method is also not without significant drawbacks. When using it in the abdominal cavity, bedsores of the implant may develop in the intestine or bladder, suppurate, reject, migrate, leading to relapse of hernias, and intestinal obstruction.

The aim of the present invention is the separation of the prolene mesh from the organs of the abdominal cavity, the prevention of pressure sores of the prolene mesh with plastic internal hernias of the abdominal cavity.

The invention "Method of plastic surgery of internal hernias of the abdominal cavity" is new, since it is unknown from the level of medicine, namely in surgery of the organs of the abdominal cavity and small pelvis.

The novelty of the invention lies in the fact that after the main stages of the operation, a flap is formed on the vascular pedicle, consisting of the left gastrointestinal artery and vein, the splenic angle of the colon is mobilized, an opening is made in the avascular zone of the mesentery of the splenic angle of the colon, an omental flap is made in the mesentery window , lower the omental flap in the pelvic area. A prolene mesh equal in area to half of its wide part is laid on a wide part of the flap, the prolene mesh is fixed to the flap at the corners with separate knotted sutures, they retreat from the edge of the mesh upward towards the vascular pedicle by a distance equal to half the mesh width, the vascular pedicle is fixed at this distance to the middle of the net with separate seams, stitch the free edges of the stuffing box over the net, stitching the edges of the net and the edges of the stuffing box.

In the available information sources of Russia, the CIS and foreign countries, it was not possible to find a method similar to the proposed method for plastic surgery of internal hernias of the abdominal cavity.

The invention "Method of plastic surgery of internal hernias of the abdominal cavity" is industrially applicable, as it can be repeated many times in the treatment of hernias of the abdominal cavity in surgical hospitals, especially oncology centers: oncologic dispensaries, oncological research institutes.

The method is as follows:

An extended operation is performed to remove malignant tumors of the pelvic organs, after removing the drug, the perineal wound is sutured in layers, tightly. It is drained by tubular drainage, the drainage is removed through contraperture in the perineum. A large omentum is cut off from the transverse colon in the abdominal cavity, preserving the gastrointestinal vessels, a flap is cut out on the vascular pedicle, consisting of the left gastrointestinal artery and vein, the splenic angle of the colon is mobilized, the splenic angle of the colon is mobilized, and an opening is made into the vascular zone of the mesentery of the splenic angle of the colon, and an omental flap is performed in the mesentery window, the omental flap is lowered into the pelvic area. A prolene mesh equal in area to half of its wide part is laid on a wide part of the flap, the prolene mesh is fixed to the flap at the corners, with separate nodal sutures, they retreat from the edge of the mesh upward towards the vascular pedicle by a distance equal to half the mesh width, the vascular pedicle is fixed on this distance to the middle of the net with separate seams, stitch the free edges of the stuffing box over the net, stitching the edges of the net and the edges of the stuffing box.

Formed a three-layer flap, including a prolene mesh and an omentum, close the pelvic floor defect.

Example: Patient D., 63 years old, medical history No. 10276 / s, was admitted to the thoraco-abdominal department of the Rostov Research Institute on 3.10.07 with a diagnosis of cancer of the lower ampullar rectum, St II, column 2. T4N0M0. On 05.06.09, a laparotomy was performed under endotracheal anesthesia, during revision of the abdominal cavity revealed: a tumor of the lower ampullar rectum 7 × 6 cm in size, circularly narrowing intestinal lumen, dense, tuberous, no distant metastases were detected. It was decided to perform abdominal-perineal extirpation of the rectum. The rectum with pararectal fiber, lymphatic dissection of the paraaortic and iliac lymph nodes, and pelvic muscle resection were mobilized and removed in a single block. After removal of the drug, the perineal wound is sutured in layers. A large omentum was cut off from the transverse colon in the abdominal cavity, preserving the gastrointestinal vessels, a flap was formed on the vascular pedicle, consisting of the left gastrointestinal artery and vein, the splenic angle of the colon was mobilized, an opening was made in the avascular zone of the mesentery of the splenic corner of the colon , had an omental flap in the mesentery window, lowered the omental flap in the pelvic area. A prolene mesh was placed over a wide part of the flap, equal in area to half of its wide part, the prolene mesh was fixed to the flap at the corners with separate interrupted sutures, they retreated from the edge of the net upward towards the vascular pedicle by a distance equal to half the mesh width, the vascular pedicle was fixed at this distance to the middle of the net with separate seams, stitched the free edges of the gland over the net, stitching the edges of the net and the edges of the gland flap. A formed three-layer flap, including a prolene mesh and an omentum, closed the pelvic floor defect.

The abdominal cavity is drained. Drainage is installed in the pelvis, removed in the right hypogastrium. The abdominal cavity is sutured in layers. Iodine. Aseptic dressing. The patient was discharged 12.10.07 (on the 9th day) in satisfactory condition. Sutures were removed on the 20th day, sutures of the perineal wound were removed on the 35th day. 3 weeks after surgery, the patient was sent to radiation therapy. There were no complications associated with the development of pressure sores in the loops of the small or large intestine, bladder, suppuration or rejection of the mesh.

The technical and economic effectiveness of the method lies in the fact that it allows you to separate the prolene mesh from the organs of the abdominal cavity and tissues of the wound cavity, as well as to prevent the development. The method allows to reduce the frequency of postoperative complications of bedsores of the prolene mesh in the loops of the small and large intestines, fistulas, suppuration of the mesh and its rejection, the formation of adhesions and intestinal obstruction and to improve the quality of life of patients.

Claims (1)

The method of plastic surgery of internal hernias of the abdominal cavity, including the elimination of hernial gates, characterized in that a flap is formed from a large omentum on a vascular pedicle consisting of the left gastrointestinal artery and vein, the splenic angle of the colon is mobilized, an opening is made in the avascular zone of the mesentery of the splenic corner of the colon intestines, conduct the formed flap into the mesentery opening, lower it into the pelvic area, put on a wide part of the flap a prolene mesh, equal in area to half its wide parts, fix the prolene mesh to the flap at the corners with separate nodal sutures, retreat from the edge of the mesh up towards the vascular pedicle by a distance equal to half the width of the mesh, fix the vascular pedicle of the flap at this distance to the middle of the mesh with separate sutures, stitch the free edges of the flap above the mesh, stitch the edges of the mesh and the edges of the flap.