RU2449735C2 - Method of increasing volume of abdominal cavity in treatment of patients with large ventral hernias - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to herniology. After performing main stages of herniotomy, separation of subcutaneous adipose cellular tissue from underlying rectus sheaths from both sides at the distance 8 cm more laterally than white line of abdomen equal in length to diameter of hernial orifice is made in sharp way. Boundary of lateral edge of rectus is determined. Indenting 1 cm from lateral edge of recti from both sides, longitudinal dissection of anterior leaves of recti sheaths is carried out with cuts, parallel to white line of abdomen. From both sides anterior leaves of recti sheaths are cut off from tendinous intersection of recti. This results in great mobility of anterior leaves of recti sheaths. After that, anterior leaves are displaced in medial direction and sewn to each other with separate interrupted sutures at the distance 0.5 cm from each other. After that, wound is sutured.

EFFECT: method makes it possible to prevent hernia recurrence.

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Description

The invention relates to medicine, namely to surgery.

In modern surgery, the issues of surgical treatment of patients with large ventral hernias remain extremely relevant. Moreover, in recent decades there has been an increase in the number of surgical interventions on the abdominal organs. An important role in preventing hernia recurrence belongs to the reduction of intra-abdominal pressure, on which both early and late postoperative complications directly depend. Correction of the level of intra-abdominal hypertension ensures the normalization of perfusion of the tissues of the abdominal wall, contributing to the formation of a full scar. Of the many proposed methods of hernia repair in the treatment of ventral hernias, alloplastic methods can provide correction of the level of intraperitoneal hypertension. However, these methods have many disadvantages. To date, there are few autoplastic hernia repair techniques to reduce intra-abdominal pressure, which necessitates the development of anatomically sound pathways that can solve the problem under consideration.

The prototype method, the authors propose a method of reducing intra-abdominal pressure in surgical diseases of the abdominal cavity according to Ramirez. With surgical intervention in conditions of increased intra-abdominal pressure, the front sheets of the vagina of the rectus abdominis muscles are initially mobilized to the spigel line on both sides. After that, along the edge of the muscle part of the external oblique muscle of the abdomen, its tendon part intersects along the entire length from the costal arch to the ilium. This achieves a reduction in intra-abdominal pressure. (V.V. Zhebrovsky, F.N. Ilyichenko - Atlas of operations for abdominal hernias - Simferopol - 2004 - p.227).

The disadvantages of the method

1. Technical complexity.

2. Injury.

3. Promotes the formation of a number of functional and degenerative complications.

The authors offer their own method for repairing a hernial defect in the localization of a hernia in the epigastric and mesogastric regions. After the main stages of hernia repair are performed, the patient is acutely separated from the subcutaneous fatty tissue from the underlying rectus sheaths of the rectus abdominis muscle on both sides to a distance of 8 cm lateral of the white line of the abdomen along a length equal to the diameter of the hernial portal. The boundary of the lateral edge of the rectus abdominis muscles is determined. On two sides, departing from the lateral edge of the rectus muscles 1 cm, a longitudinal dissection of the anterior sheets of the vagina of the rectus abdominis is carried out with sections parallel to the white line of the abdomen. On both sides, the front leaves of the vagina of the rectus abdominis are cut off from the tendon ligaments of the rectus abdominis. This achieves greater mobility of the anterior leaves of the vagina of the rectus abdominis muscles. Further, the front sheets are displaced medially and stitched together by separate interrupted sutures at a distance of 0.5 cm from each other. Then, suturing of subcutaneous fatty tissue and nodal suturing on the skin wound are carried out. The technical result of the proposed method is to reduce intra-abdominal pressure by increasing the volume of the abdominal cavity, improving microcirculation in the anterior abdominal wall, using own tissues to close the hernial defect.

The method proposed by the authors, in our opinion, has the following advantages:

1) is optimal for reducing intra-abdominal pressure;

2) easy to execute;

3) less traumatic;

4) does not require the use of additional equipment;

5) does not require repeated reconstructive surgery;

6) helps prevent the development of postoperative complications associated with an increase in intra-abdominal pressure (intestinal obstruction, ascites, thrombophlebitis of the veins of the lower extremities, etc.).

The authors operated on 15 people according to the method described above. Clinical example: case history No. 1025 - 2008. Patient A.M., 52 years old, was admitted to the hospital with a diagnosis of postoperative ventral epigastric hernia of large sizes (diameter of hernia gate 20 cm). After the main stages of hernia repair were performed, the anterior vaginal sheets of the rectus abdominis were revised. It is noted that the leaves of the vagina are not fibrous, dense. The intervention was performed according to the above method. On the second day, the patient's condition is satisfactory, there are no signs of cardiovascular and respiratory failure, intestinal motility has recovered. In satisfactory condition on the 10th day after the operation she was discharged home. With further observation of the negative consequences of the operation, it was not revealed, it is able to work.

Claims (1)

A method of increasing the volume of the abdominal cavity in the treatment of patients with large ventral hernias, which includes the acute way to separate the subcutaneous fat from the underlying rectus sheaths of the abdominal muscles on both sides at a distance of 8 cm lateral to the white line of the abdomen along a length equal to the diameter of the hernial portal, with the definition of the border the lateral edge of the rectus abdominis muscles, followed by a longitudinal section of the anterior sheets of the vagina of the rectus abdominis muscle, with incisions parallel to the white line of the abdomen of two sides, departing from the lat of the natural edge of the rectus muscles 1 cm, and by cutting off the tendon ligaments from the rectus abdominis, the anterior sheets are displaced medially and sutured together by separate interrupted sutures at a distance of 0.5 cm from each other, then suture of subcutaneous fatty tissue and nodal sutures are applied to the skin wound .