RU2489973C1 - Method of ventral hernia plasty - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular, to herniology. Greater omentum is cut closer to left edge. Flap is cut out on vascular pedicle in left part of greater omentum with two omentum arteries, which are anastomosed with each other. Larger - right part of transected omentum is sutured to wound from bellow, lower - left part with two anastomosing omentum arteries are brought above sutured peritoneum and laid along entire wound length, forming two layers of greater omentum transplants.

EFFECT: method makes it possible to prevent failure of sutures and recurrences of ventral hernias due to improvement of blood supply of tissues for hernia plasty.

1 ex, 3 dwg

Description

The invention relates to surgery, in particular, to methods for surgical treatment of abdominal hernias.

A known method of surgery for umbilical hernia according to Sapezhko, in which the skin is separated from the aponeurosis to the right and left, after the contents of the hernia have been repaired, the hernial sac is excised. The peritoneal-aponeurotic edges of the abdominal wall are laid on top of each other like the floors of a double-breasted frock coat (I.M. Matyashin, A.M. Gluzman - Handbook of Surgery, Kiev "Health" 1979, p. 249). The disadvantage of this method is the risk of failure of the sutures of the aponeurosis of the external oblique muscle of the abdomen in connection with its razvolnenie, impaired blood supply, diastasis of the rectus muscles. In this case, relapse of hernias is possible.

There is also a method of surgical treatment of postoperative ventral hernias, which consists in the fact that before plastic suturing of the wound of the abdominal wall, the portion of the anterior surface of the greater omentum is hemmed as a patch to the parietal peritoneum in the circumference of the wound (K.D. Toskin, V.V. Zhebrovsky - Hernias abdominal wall. Moscow, "Medicine", 1990, p.205). Avoiding tension, the most mobile section of the greater omentum without mobilization is laid so as to delimit the postoperative wound from the abdominal organs. Then, with interrupted sutures, it is hemmed to the parietal peritoneum in the circumference of the wound. Thus, the intact posterior surface of the greater omentum adjoins the abdominal organs. This allows the prevention of adhesive-intestinal obstruction, however, it does not save against relapses with autoplastic methods for operating postoperative hernias, which range from 11.8% to 31.6% (K.D. Toskin, V.V. Zhebrovsky, 1990, p. 207, table 11)

When using the described method of surgical treatment of hernias, there is no improvement in the blood supply to plastic tissues, because there is space between the large omentum and the surrounding tissues. In addition, the greater omentum is not used on the vascular pedicle, which also does not improve blood supply and prevent hernia recurrence. Finally, there is no direct contact between the large omentum and suture strip with plastic hernia, which can lead to failure of the joints.

The objective of the claimed invention is to increase the efficiency of surgical treatment of ventral hernias by improving blood supply to the tissues of the omentum vessels.

The problem is solved due to the fact that dissect a large omentum closer to the left edge; a flap is cut out on the vascular pedicle on the left side of the greater omentum with two omental arteries that anastomose with each other; the larger - the right part of the dissected omentum is sutured to the wound, the smaller - the left part with two anastomosing omental arteries is removed over the sutured peritoneum and laid along the entire length of the wound, forming two floors of large omentum transplants.

Earlier Z.M. Sigal discovered the phenomenon of interaction and transformation of arterial flows (Z. M. Sigal. - Biomechanical phenomena of interaction and transformation of arterial flows, “Medical Biomechanics”, Riga, 1986, pp. 351-356). Based on this discovery, a flap is cut out with two omental arteries, anastomosing with each other, since the collision of arterial flows leads to an increase in pressure, thereby switching the blood flow to the next caliber elements, and ultimately this leads to an improvement in blood flow in the omentum flap.

The use of the claimed invention allows to improve blood supply to tissues for plastic of ventral hernias and helps to prevent recurrence of hernias.

The claimed method is illustrated by drawings, which depict the progress of the operation: Fig. 1 - a large omentum is dissected into two unequal parts, a smaller one with two omental arteries, a large one is on the right side; Fig. 2 - the left part of the greater omentum is brought out above the peritoneum; the right side of the greater omentum is hemmed from below to the peritoneum; Fig. 3 - the left part of the greater omentum is laid on the peritoneum.

The claimed method is implemented as follows. After the midline incision and reduction of the contents of the hernia, the hernial sac is excised. After dissection of the greater omentum, a flap on the vascular pedicle with two omental arteries extending from the left gastro-omental artery is cut out in its left part. At the same time, these omental arteries should anastomose with each other at the free edge of the greater omentum. Patency of the anastomoses is established using the Sigal finger test: the anastomoses of the gland arteries are pressed with the index finger from the inside of the omentum until the blood flow stops, and then after release (lowering the pressure on the anastomosis), blood flow is observed. If the pulsation persists, the anastomosis is passed, and the flap of the greater omentum is suitable for use. This left flap of the greater omentum is cut out, starting from the distal end to a proximal length equal to the surgical wound. The peritoneum is sutured to the tissue of the omentum. The flap of the right part of the omentum is hemmed from the inside to the peritoneum. The smaller left part of the greater omentum with two anastomosing omental arteries is removed over the sutured peritoneum and laid along the entire length of the wound, forming two floors of transplants of the omentum.

Example.

Patient A., 10 years old, diagnosis - umbilical hernia.

Hernia Surgery. Plastic surgery according to Sapezhko with tissue omentization for hernia repair.

Under mask anesthesia, a semicircular incision was made 5 cm long under the umbilicus, a hernial sac was isolated in layers, opened, no contents were found. Around the hernia gate, an aponeurosis was separated. The hernial sac was cut off, its dimensions 2.0 × 1.5 cm. Hemostasis. After dissection of the greater omentum, a flap was cut out on the vascular pedicle in the left part of the omentum with two omental arteries closer to the left edge. Large - the right side of the dissected large omentum was hemmed to the wound; smaller - the left part was brought out over the sutured peritoneum and laid on the sutured peritoneum.

The wound is sutured in layers. An aseptic dressing is applied. During the stay in the hospital, the wound without signs of inflammation, healed by primary intention. The patient was observed for two years. There was no recurrence of hernia and inconsistency of the sutures. No complaints.

Claims (1)

The method of plasty of abdominal hernias, including suturing the tissue of the anterior abdominal wall, characterized in that a large omentum is dissected closer to the left edge; a flap is cut out on the vascular pedicle on the left side of the greater omentum with two omental arteries that anastomose with each other; the larger - the right part of the dissected omentum is sutured to the wound from below, the smaller - the left part with two anastomosing omental arteries is removed over the sutured peritoneum and laid along the entire length of the wound, forming two floors of large omentum transplants.

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