RU2487671C1 - Method of navel preservation in abdominal plasty simultaneous with ablation of umbilical hernia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to herniology. Before operation marking of dermal flap near navel, representing isosceles triangle with rounded apex - navel, with lateral sides of triangle lying on lines, connecting apex with edges of skin cut above pubis for abdominal plasty is made. Lateral sides of dermal flap have dimensions not more than 5 cm. After that, de-epithelisation of paraumbilical dermal flap is performed, it is cut out with vertical cuts to aponeurosis in order to ablate umbilical hernia with isolation of hernia sac, after which hernia plasty is carried out in accordance with standard methods. After suprapubic cut skin is detached, excessive parts are ablated and fixed in new position with cutting hole for navel.

EFFECT: method improves cosmetic result of operation.

1 ex, 1 dwg

Description

The invention relates to medicine, namely to surgical cosmetology and can be used for simultaneous removal of umbilical hernia when performing abdominoplasty.

Umbilical hernias in adults account for 3-5% of all abdominal hernias. They occur mainly in women over the age of 30, which is facilitated by pregnancy and childbirth. Also one of the causes of umbilical hernia is obesity. Radical treatment of umbilical hernia is only surgical.

A known method of performing hernioplasty, which consists in a horizontal section in the navel with its subsequent excision (V.I. Orokhovsky. Basic herniotomy, 2000, p. 210). The main disadvantage of this method is a violation of the anatomical structure of the anterior abdominal wall.

A known method of open hernia repair, which consists in the fact that plastic hernia is performed after cutting off the navel from the anterior abdominal wall. In this case, simultaneous abdominoplasty with hernia repair is not possible, since the blood supply to the navel is impaired and there is a high probability of necrosis (Voskresensky N.V., Gorelik E.L. Surgery of hernias of the abdominal wall. M., 1965).

In addition, another method is known - endoscopic. A hernia repair is performed from the side of the abdominal cavity using endoscopic equipment. Moreover, to achieve the result, a prolene mesh is used. The disadvantage is the duration of the operation and the use of expensive instruments (Rutenberg G.M., Levin L.A. Video endoscopic interventions on the abdomen and retroperitoneal space: a Manual for doctors. St. Petersburg, 2002, p.225-237).

There is also a method of preserving the navel with abdominoplasty simultaneously with the removal of the umbilical hernia, selected as a prototype, including suprapubic incision, correction of the umbilical hernia, abdominoplasty operation (RF patent No. 2401073). During the operation, the abdominal cavity is opened with a suprapubic section and all manipulations are performed under the aponeurosis at a distance from the navel in order to preserve the perforating vessels that feed the navel that go next to it. This technique is quite traumatic.

The task of the invention is to reduce the invasiveness of the operation when removing the umbilical hernia simultaneously with abdominoplasty and to improve the cosmetic effect of the operation.

A method for preserving the navel with abdominoplasty while simultaneously removing the umbilical hernia, including suprapubic incision, correction of the umbilical hernia, surgery of the abdominoplasty, according to the invention, before the operation, mark the dermal flap near the navel, which is an isosceles triangle with a rounded apex - the navel, and the lateral sides of the triangle lines connecting the apex to the edges of the skin incision above the pubis for abdominoplasty, with the sides of the dermal flap measuring no more than 5 centimeters meters, then de-epidermization of the umbilical dermal flap is performed, it is cut with vertical incisions to the aponeurosis to remove the umbilical hernia with a hernia sac and then the hernia is plasticized according to the standard procedure, the skin after a suprapubic incision is peeled off, the excess is removed and fixed to a new position with the opening of the navel .

The result of the proposed solution is achieved by maintaining blood supply to the umbilicus by preserving the dermal flap around the navel while removing the umbilical hernia with simultaneous abdominoplasty.

During the operation of excision of the umbilical hernia, it is necessary to maintain normal nutrition of the navel. Isolation of the umbilical dermal flap preserves the blood supply to the navel and allows for hernia surgery through a small incision around the navel, which reduces the morbidity of the operation. For epidermization of the umbilical dermal flap, it is necessary to mark this flap, which is an isosceles triangle with a navel top, and the sides of the triangle lie on the lines connecting the top with the edges of the skin incision above the pubis for abdominoplasty. The size of the lateral sides of the dermal flap is not more than 5 cm, which is necessary and sufficient to maintain blood supply to the navel. These dimensions of the dermal flap were obtained empirically after a series of operations. Positive results of operations made it possible to determine the initial parameters.

Then, through a small incision around the navel, plastic of the umbilical hernia is performed according to the standard method. After removal of the umbilical hernia, abdominoplasty is also performed according to the standard method without fear of inadequate blood supply to the navel.

Patent studies have not identified methods for the removal of umbilical hernias in abdominoplasty, characterized by the claimed combination of features, therefore, we can assume that this method meets the criterion of "novelty."

The use of a combination of distinctive features is also not known, which indicates compliance with the criterion of "inventive step".

The inventive method can be carried out in any specialized medical institution, therefore, it meets the criterion of "industrial applicability".

The results of the proposed method is illustrated in Figure 1, where the number 1 indicates the navel, 2 - zone of epidermization, 3 - line suprapubic section.

The essence of the method is as follows.

In an upright position, preoperative marking is applied.

The marking consists of two components - the marking directly of the abdominoplasty operation and the marking of the dermal flap near the navel. The dermal flap is an isosceles triangle with a rounded top - the navel. The lateral sides of the triangle lie on the lines connecting the top with the edges of the skin suprapubic incision for abdominoplasty, the base is the line connecting these segments. The size of the lateral sides of the dermal flap should be no more than 5 cm.

After treating the surgical field with an antiseptic, the area of surgical intervention is infiltrated with a solution containing a local anesthetic (for example, lidocaine 0.2%) with the addition of adrenaline at a concentration of 1: 500000. The operation is performed under general anesthesia.

Then, epidermalization of the umbilical dermal flap is performed along the border of the previously applied marking and its cutting with vertical sections to the aponeurosis. Correction of umbilical hernia is carried out according to standard methods (according to Mayo or Sapezhko). At the same time, the umbilical ring is allocated adequately to the need for each particular case, the navel can even be cut off completely, since there is no violation of blood supply, it remains due to the cut dermal flap.

At the same time, hernia gates can be mobilized quite widely - blood supply to the navel due to the dermal flap does not suffer. After completion of the hernia repair stage, an abdominoplasty operation is performed according to the standard technique also without fear for inadequate blood supply to the navel.

After the operation, it is supposed to use a bandage that is worn for 1.5 months. Sutures are removed on the 10th day after surgery.

The method is illustrated by examples of specific performance.

Example. Patient N., 36 years old, complained of excess skin of the anterior abdominal wall and hernial protrusion in the navel.

On examination, the skin of the anterior abdominal wall is flabby with striae in the hypogastric region, there is an umbilical hernia, a hernial opening of up to 0.8 cm. Abdiminoplasty with simultaneous hernia repair was performed according to the proposed method. In the operating room, the anterior abdominal wall is treated with an antiseptic solution - betadine. The area of operation was infiltrated with a solution of lidocaine 0.2% - 700 ml. with the addition of adrenaline in a concentration of 1: 500000. With the help of scalpel No. 10, epidermalization of the umbilical flap is performed according to the preliminary marking. After cutting off the umbilicus, the hernia sac and Mayo plastic were extracted. Next, the skin flap was peeled off along the borders of the previously applied marking, excess skin was removed, the flap was fixed in a new position with a hole for the navel cut out. Layer wound closure was performed, leaving two drains for active aspiration. Aseptic dressings were applied, compression underwear was put on. The course of the postoperative period without features. Drainages removed on the 2nd day, sutures removed on the 10th day. Wound healing by primary intention. Observation for 1.5 years - recurrence of a hernia was not detected.

The proposed method allows you to radically get rid of umbilical hernia simultaneously with the operation of abdominoplasty with a good cosmetic effect.

Claims (1)

A method for preserving the navel with abdominoplasty simultaneously with the removal of the umbilical hernia, including suprapubic incision, correction of the umbilical hernia, abdominoplasty operation, characterized in that before the operation, the dermal flap is marked up near the navel, which is an isosceles triangle with a rounded apex - the navel, and the lateral sides on the lines connecting the top with the edges of the skin incision above the pubis for abdominoplasty, and the sides of the dermal flap have a size of not more than 5 cm, for In this, de-epidermization of the umbilical dermal flap is performed, it is cut with vertical incisions to the aponeurosis to remove the umbilical hernia with the isolation of the hernial sac and then the hernia is plasticized according to the standard procedure, the skin after the suprapubic incision is peeled off, the excess is removed and fixed to a new position with the opening of the navel.

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