RU2445011C1 - Method of implant placement - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to plastic surgery. Implant is sewn on four angles and in the middle through opposite edges with bringing out without ligating long ligatures. Implant is oriented by means of hooks from polylactic acid to aponeurosis. Angle ligatures successively, first ligatures of upper edge, then ligatures of lower edge of implant, are brought out on the abdominal wall skin by pricking out. Simultaneous traction by upper and lower angle ligatures is performed. Implant in a single step and entirely is placed in subaponeurotic space on entire area. Ligatures from the middle of opposite edges are brought out on skin. Permanent traction is applied on brought out ligatures. Aponeurosis "edge-to-edge" and soft tissues of abdominal wall are sutured. Ligatures, brought out on abdominal wall, are removed.

EFFECT: placement of implant in the claimed way prevents implant puckering, ensures stable plane location of the latter in aponeurosis suturing in case of various defects of abdominal cavity wall, including hernioplasty.

15 dwg

Description

The invention relates to methods of placement requiring no fixation to implant tissues in allogeneernoplasty and can be used in hernia surgery.

The closest to the method under consideration is, according to the authors, the method of subaponeurotic placement of the implant during allogeneioplasty, which is carried out as a result of manual placement, smoothing and constant holding of the implant with instruments, sutures or fixatives in the subaponeurotic space [1, 2]. However, unlike the claimed method, this one has another operative technique, it does not ensure the absence of folding, displacement, and reliable planar placement of the implant at all stages of allogeneioplasty and causes a number of specific complications.

SUMMARY OF THE INVENTION

Improving the quality of surgical surgical procedures in allogeneioplasty, eliminating specific complications and relapses, reducing the time of surgical intervention and the economic profitability of the operation.

Features

When performing allohernioplasty, the fixation-free implant is stitched in four corners and in the middle, through opposite edges, with the removal of long ligatures without tying (Figure No. 1-2). The implant is oriented by hooks from polylactic acid to aponeurosis. Angular ligatures sequentially, first ligatures of the upper edge, and then the ligatures of the lower edge of the implant, are displayed on the skin of the abdominal wall by punctured from the corresponding corner of the subaponeurotic space (Figure No. 3-6). Simultaneous traction for the upper and lower angular ligatures is carried out. The implant is simultaneously and completely placed in the subaponeurotic space over the entire area (Figure No. 7-8). Edge ligatures are displayed on the skin of the abdominal wall by a puncture from the corresponding edge of the subaponeurotic space (Figure No. 9). Permanent, passive traction is imposed on the removed ligatures for a stable planar placement of the implant during suturing of the aponeurosis (Figure 10-11). Suturing of the edge-to-edge aponeurosis and soft tissues of the abdominal wall is carried out (Figure No. 12-14). The ligatures brought to the abdominal wall are removed (Figure No. 15).

A positive result of the use of the invention is achieved by preventing non-targeted independent fixation, evaporation and displacement of not requiring fixation to the implant tissues when the latter is placed in the subaponeurotic space; provides a stable planar arrangement of the latter when suturing the aponeurosis; there is no need for mechanical laparolifting when placing the implant, holding the upper edge of the implant when placing the lower edge of the latter; Reduces the time of surgery.

List of figures:

1. Figure number 1. Pre-implant flashing.

2. Figure number 2. The implant is stitched in the corners and through the middle of the opposite sides.

3. Figure number 3. Excretion of the upper right angular ligature from the subaponeurotic space to the skin of the abdominal wall.

4. Figure No. 4. Withdrawal of the upper left angular ligature from the subaponeurotic space to the skin of the abdominal wall.

5. Figure No. 5. Excretion of the right lower angular ligature from the subaponeurotic space to the skin of the abdominal wall.

6. Figure No. 6. Removal of the left lower angular ligature from the subaponeurotic space to the skin of the abdominal wall.

7. Figure No. 7. Scheme - insertion of an implant into the subaponeurotic space by traction for ligatures.

8. Figure No. 8. The implant is located in the subaponeurotic space.

9. Figure No. 9. Excretion of the regional ligature.

10. Figure No. 10. Permanent, passive traction for ligatures.

11. Figure No. 11. Scheme - the implant is placed in the subaponeurotic space, a permanent traction is applied to the ligatures.

12. Figure No. 12. The aponeurosis is sutured.

13. Figure No. 13. The beginning of suturing soft tissues.

14. Figure No. 14. Scheme - suturing of the soft tissues of the abdominal wall over the implant.

15. Figure No. 15. Scheme - the result of the operation - the soft tissues of the abdominal wall are sutured, the ligatures are removed.

Bibliographic sources

1. Egiev V.N., Lyadov K.V., Voskresensky P.K. Atlas of operative hernia surgery // Moscow: Medpraktika-M - 2003. - pp. 143-187.

2. Zhebrovsky VV, Mohammed Tom Elbashir. Surgery of abdominal hernias and eventrations // Simferopol: "Business-Inform" - 2002. - pp. 355-380.

Claims (1)

A method for placing an implant, including placing the implant subaponeurotically and suturing the aponeurosis above it, characterized in that the implant, oriented with hooks from polylactic acid to the aponeurosis, is stitched in four corners and in the middle, through opposite edges, with long ligatures that are not tied to the abdominal skin the walls by pulling out from the corresponding angle of the subaponeurotic space, simultaneously pulling on the upper and lower angular ligatures, simultaneously and completely placing the implant in the subaponeurotic space over the entire area, after which edge ligatures are removed onto the skin of the abdominal wall by punctured from the corresponding edge of the subaponeurotic space, a permanent traction is applied to the ligatures, the aponeurosis is sutured and the ligatures are removed.

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