RU2589666C1 - Method for surgical treatment of partial recurrent postoperative ventral hernia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method includes, in a projection of a hernial diverticulum, making herniotomy with dissecting of existing synthetic prosthetic implant, sprouted tissues, in longitudinal direction relative to main skin incision and selecting a hernia sac which is opened for inspection of abdominal cavity and abdominal stage of operation. Abdominal cavity is closed completely using preserved shells of hernial sac. In a defect of a previously installed endoprosthesis is sewed a patch of a new synthetic prosthetic implant which is fixed by means of prolene threads along perimeters of large and small diameters.

EFFECT: inspection of abdominal cavity organs and performing abdominal stage of operation.

1 cl, 1 ex

Description

The invention relates to medicine, namely to the field of herniology surgery, and can be used for surgical treatment of patients with postoperative ventral hernia (PVH) in the formation of a defect in a previously installed endoprosthesis.

At present, the problem of choosing a method for repairing a hernial defect in relapses of PVG is unresolved. Existing methods for the rapid elimination of recurrence of PVH are used without regard to the type of hernia recurrence, as well as the integrity of the implanted endoprosthesis.

Based on the classification of recurrent hernias after hernioplasty using mesh endoprostheses, a partial recurrence of hernia was identified - due to the reduction, sliding of the endoprosthesis from one of its fixation walls more often in the lower pole. Thus, a defect less than ^1/2 _{of the} perimeter of the former hernia gate is formed, through which the hernia sac extends, that is, the endoprosthesis is one of the walls of the hernia gate [1].

There is a known method of hernioplasty for median abdominal hernias according to Belokonev V.I., when after performing a herniotomy and separating the subcutaneous fat flap from the anterior sheets of the vagina of the rectus abdominis muscles, the hernia sac is opened with its contents revised and the abdominal cavity sutured tightly. Next, a dissection anterior leaflets rectus sheaths around the hernial ring at a distance equal to _^half the width of their width. Medial flaps of the rectus muscles, rotated 180 ° without tension, sew together. A synthetic endoprosthesis is sutured between the lateral flaps of the dissected anterior sheets of the vagina of the rectus abdominis muscles with a large diameter [2].

The disadvantage of its use is the need for the initial and complete removal of the previously installed synthetic endoprosthesis, which is technically more difficult to perform, the time of surgical intervention is lengthened, the risks of intraoperative and postoperative complications increase, the tissue strength in the area of new plastic surgery decreases, and, as a result, the likelihood of relapse of the disease increases. This method is taken as a prototype.

The aim of the invention is to develop a method for the rapid elimination of partial relapse of a postoperative hernia, accompanied by the formation of a defect in a previously installed endoprosthesis with subsequent strengthening of the plastic zone.

This goal is achieved by the fact that the dissection of the previously installed synthetic endoprosthesis is performed in the longitudinal direction relative to the main skin incision, the abdominal cavity is closed using the saved shells of the hernial sac; a patch from a new synthetic endoprosthesis is sewn into the defect of the previously installed endoprosthesis, which is fixed with a prolene thread around the perimeters of large and small diameters.

The technical result of the proposed method is the ability to perform plastic surgery in case of a defect of a previously installed synthetic endoprosthesis, reducing the operation time by preserving a previously installed endoprosthesis that has already been integrated into the patient’s tissue, reducing the likelihood of intraoperative and postoperative complications, ensuring the reliability of the plastic, reducing the likelihood of a relapse of the disease.

A method for the surgical treatment of partial relapse of a postoperative ventral hernia is implemented as follows.

In the projection of hernial protrusion, a herniotomy is performed, with a dissection of the previously established synthetic endoprosthesis, which has germinated with tissues, in the longitudinal direction relative to the main skin incision, and a hernial sac is secreted, which is opened to revise the abdominal organs and perform the intraperitoneal stage of the operation. The abdominal cavity is closed tightly using stored hernial sac shells. Next, a patch from a new synthetic endoprosthesis is sewn into the defect of the previously installed endoprosthesis, which is fixed with a prolene thread around the perimeters of large and small diameters.

This method does not have the disadvantage of a method of combined PVG repair, in which it would be necessary to first remove the previously installed synthetic endoprosthesis with the subsequent completion of all stages and implantation of a new synthetic endoprosthesis. Reliability of hernioplasty and a reduction in the likelihood of recurrence of the disease is achieved by suturing the shells of the hernial sac and establishing a patch from a new synthetic endoprosthesis.

A method for surgical treatment of partial relapse of a postoperative ventral hernia is illustrated by a clinical example.

Patient U., 1948 Diagnosis. Recurrent postoperative ventral hernia MW4R2. The first operation was complicated by skin necrosis over a large area, which required the completion of autodermal plasty. Soon the patient had 2 hernias with a diameter of 3 cm and 4 cm. A herniotomy was performed, with an incision of the old synthetic endoprosthesis that had germinated with tissues in the longitudinal direction relative to the main skin incision and 2 hernial sacs were selected, after the revision and opening of which the intra-abdominal stage of the operation was performed, consisting of in the separation of adhesions. The abdominal cavity was closed tightly using stored hernial sac shells. New polypropylene endoprostheses with a diameter of up to 4.5 cm were laid in the formed defects, which are sewn along the two perimeters of large and small diameters to the old endoprosthesis with 3.0 proline threads. The edges of the skin are sewn over the endoprostheses. Wound healing partially took place by secondary intention. There are no intraoperative and postoperative complications. The patient was examined in February 2015, there was no recurrence of hernia.

The proposed method for the surgical treatment of partial relapse of a postoperative ventral hernia can be effectively used in the surgical departments of multidisciplinary medical institutions.

INFORMATION SOURCES

1. Melentyev O.N. Treatment of patients with postoperative ventral hernia: ultrasound diagnostics and surgical tactics. - Abstract. diss. for the candidate of medical sciences. Samara - 2010.

2. Belokonev V.I .; Belousov D.V .; Alexandrov I.K .; Grachev B.D .; Makhova A.N. Method of hernioplasty with median hernias of the abdomen. Patent for the invention RU 2123292 from 05.25.1995.

Claims (1)

A method for surgical treatment of partial relapse of a postoperative ventral hernia, including herniotomy, isolation and opening of the hernial sac, revision of its contents, performing the intra-abdominal stage of the operation, suturing the abdominal cavity with a continuous suture tightly, characterized in that the section of the previously installed synthetic endoprosthesis is performed in the longitudinal direction relative to the main incision skin, abdominal cavity is closed using stored hernial sac shells; a patch from a new synthetic endoprosthesis is sewn into the defect of the previously installed endoprosthesis, which is fixed with a prolene thread around the perimeters of large and small diameters.