RU2611736C1 - Method for umbilical hernia surgery - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, specifically to hernia surgery. The method includes access to the hernia sac through the navel , isolation and treatment, exposure of the hernia defect edges without clipping of scar tissue attached to the umbilical ring along the circle. Hernia defect is eliminated by overlaying of polypropylene stitches on the edges with stitching of fascia and scar tissue attached to the umbilical ring along the circle. Hernia defect is eliminated by a double-row polypropylene continuous suture, longitudinally or transversely. At first, an external susture with non-thightened loops is applied, then an internal suture is applied with the same thread in the opposite direction under the external suture and tightened; stitches of the internal suture are smaller than those of the external one, and once it is completed, the external suture is tightened and thread ends are tied. The external suture is applied at the distance of 1.0-1.5 cm from the edges of the hernia defect. The internal suture is applied at the distance of 0.5-1.0 cm from the edges of the hernia defect. At the end of the polypropylene suture thread a soft polymeric ring is attached, through which each loosened loop is passed during external susture application, and after the internal susture is applued, the ring is cut and removed from the wound. Before tightening, the external susture is placed under its loops on the internal suture line on the rolled polypropylene mesh, and then the external suture is tightened.

EFFECT: surgery method, which increases the reliability of plastics and prevents recurrence of hernias.

4 cl, 2 dwg, 2 ex

Description

The invention relates to medicine, namely to surgery, and is intended to increase the effectiveness of plastic for umbilical hernias.

A known method of plastic surgery for umbilical hernias according to Lexer (Atlas of surgical hernia surgery. V.N. Egiev, K.V. Lyadov, P.K. Voskresensky. Medical practice. - M., Moscow, 2003, - pp. 144-145 ) The operation begins with a transverse incision of the skin immediately below the navel. Cut the skin and subcutaneous tissue to aponeurosis. A hernial sac is isolated and inserted into the abdominal cavity or excised. Along the perimeter of the hernial foramen 3-4 cm, an aponeurosis and anterior vaginal sheets of the rectus abdominis are secreted. Next, around the hernia gate impose a purse string suture with polypropylene thread No. 0. The purse string suture is tightened and tied. Then an additional 3-4 single sutures are placed over it, bringing together the edges of the vagina of the rectus abdominis muscles.

The method is extremely simple to execute. However, it is used extremely rarely and more often with small hernias in children. In adults, the method gives a large number of relapses. The thing is that under the influence of intra-abdominal pressure, the threads erupt over time.

The closest analogue to the claimed invention is a known method of plastic surgery for umbilical hernias (RF patent No. 2504337). The method includes access through the navel to the hernial sac, isolation and processing of the latter, exposure and plasticity of the hernial defect with the creation of duplicate aponeurosis, layer-by-layer suturing of tissues. In this case, after exposure of the hernial defect, the scar tissue attached to the umbilical ring around the circumference is not cut off from it, and the hernia defect is plastic, creating a duplicate of the aponeurosis, by applying U-shaped polypropylene sutures to its edges with suturing and attached to the umbilical ring around the circumference of the scar tissue .

The advantage of the method is its simplicity, low invasiveness and reliability. The positive properties of the technique include the absence of contact with subcutaneous fat during surgery.

The disadvantage of the above method is its low effectiveness in terms of relapses with large umbilical hernias, when weakness and thinning of the aponeurotic tissues are noted. The application of additional reinforcing sutures is not possible, since after the first row it is not possible to see the aponeurosis due to the scar tissue attached to the umbilical ring around the circumference.

The objective of the proposed technical solution is to develop an effective method of plastic for umbilical hernias, when for plastic use is attached to the umbilical ring around the circumference of scar tissue.

The technical result of the proposed method is to increase the effectiveness of plastic with umbilical hernias due to:

- elimination of the hernial defect with a continuous two-row polypropylene suture longitudinally or transversely, while first applying the outer suture to form loops without tightening them, then under the stitches of the external suture with the same thread in the opposite direction, tighten the inner suture with finer stitches than the outer one, and then its completion tighten the outer seam and tie the ends of the thread;

- overlay of the external suture, departing 1.0-1.5 cm from the edges of the hernial defect;

- overlay of the internal suture, departing 0.5-1.0 cm from the edges of the hernial defect;

- attaching at the end of the suture polypropylene yarn a ring of soft polymeric material through which, when applying the external suture, each loose loop is passed, followed by cutting and removing the ring from the wound after the internal suture is applied;

- laying before tightening the outer seam under its loop on the line of the inner seam rolled into a roller polypropylene mesh, followed by tightening the outer seam.

The technical result is achieved by the fact that the method of surgery for umbilical hernias includes access through the navel to the hernial of the bag, isolation and processing of the latter, exposure of the edges of the hernial defect without cutting off the umbilical ring attached to it around the circumference of the scar tissue, eliminating the hernial defect by applying polypropylene sutures to it edges with the sewing of the aponeurosis and attached to the umbilical ring around the circumference of the scar tissue, layered wound closure.

The difference of the proposed method is that the elimination of the hernial defect is carried out by a two-row continuous polypropylene suture longitudinally or transversely, while first applying the outer suture with the formation of loops without tightening them, then under the hinges of the outer suture with the same thread in the opposite direction, tightening the inner suture with smaller ones stitches than the outer, and after its completion, tighten the outer seam and tie the ends of the thread.

The difference of the method lies in the fact that the external suture is applied, departing 1.0-1.5 cm from the edges of the hernial defect.

The difference of the method also lies in the fact that the inner suture is applied, departing 0.5-1.0 cm from the edges of the hernial defect.

The difference of the method is also that at the end of the suture polypropylene thread a ring of soft polymeric material is attached, through which each loose loop is passed when an external suture is applied, and after the internal suture is applied, the ring is cut and removed from the wound.

The difference is that before tightening the outer seam, they lay a polypropylene mesh rolled into a roller under the hinges on the line of the inner seam, and then tighten the outer seam.

A comparative analysis of the proposed method and the prototype shows that the claimed method differs from the known above methods. These differences allow us to conclude that the claimed technical solution meets the criteria of the invention of "novelty."

From the analysis of patent and specialized literature, the authors found that the proposed technical solution has features that distinguish it not only from the prototype, but also from other technical solutions in this field of medicine. We have not found a method of plastic surgery for umbilical hernias containing the distinctive techniques of the proposed method.

The proposed method of surgery for umbilical hernias includes access through the umbilicus to the hernial sac, isolation and processing of the latter, exposure of the edges of the hernial defect without cutting off the umbilical ring attached to it around the circumference of the scar tissue, eliminating the hernial defect by applying polypropylene sutures to its edges with the aponeurosis and attached to the umbilical ring around the circumference of scar tissue, layered suturing of the wound. In this case, the hernial defect is eliminated by a double-row continuous polypropylene suture longitudinally or transversely, while first applying the outer suture to form loops without tightening them, then under the stitches of the external suture with the same thread in the opposite direction, tighten the inner suture with smaller stitches than the outer one, and after it is completed, the outer seam is tightened and the ends of the thread are tied. This technique allows a double-row suture to be inserted with the aponeurosis inserted and attached to the umbilical ring around the circumference of the scar tissue. In this case, the inner row of the seam is strengthened by the outer not only in front, but also in the back. All this significantly reduces the risk of umbilical hernia recurrence.

An external suture is applied, departing 1.0-1.5 cm from the edges of the hernial defect. This size of the indentation is optimal from the point of view of anatomy and the greatest strength of the outer seam.

An internal suture is applied, departing 0.5-1.0 cm from the edges of the hernial defect. This indentation size for the inner seam is determined by the indentation for the outer seam.

At the end of the suture polypropylene yarn, a ring of soft polymeric material is attached, through which, when an external suture is applied, each loose loop is passed, and after the internal suture is applied, the ring is cut and removed from the wound. The specified ring does not allow the end of the thread to go into the fabric, and also allows you to fix the loop of the loose outer seam in one place, which simplifies the imposition of the inner seam.

Before tightening the outer seam, lay under its loops on the line of the inner seam a polypropylene mesh rolled into a roller, and then tighten the outer seam. With this technique, when the outer seam is applied to the tread, tissue tension is eliminated. In this situation, the mesh is fixed without the risk of significant mixing and wrinkling due to the strong fixation and twisting into the roller. All this improves the quality of the plastic, especially with a decrease in the strength of the aponeurosis.

All the signs of an independent claim of the claimed method are essential, since they are necessary to achieve the specified technical result.

Symptom: - “the method of operation for umbilical hernias includes access through the navel” - it is known and determines the nature of access to the operative impact zone and the structure through which it passes.

Symptom: - “isolation and processing of the hernial sac” - is known, determines the necessary stage of intervention on the hernial sac.

Symptom: - "exposure of the edges of the hernial defect without clipping from the umbilical ring attached to the circumference of the scar tissue" - is known, determines the necessary surgical procedures before performing plastic surgery.

Sign: - “elimination of a hernial defect by applying polypropylene sutures to its edges with an aponeurosis inserted and scar tissue attached to the umbilical ring around the circumference, layer wound closure” - is known, it determines the nature of the hernial defect elimination.

Sign: - “repair of the hernial defect is carried out by a double-row continuous polypropylene suture longitudinally or transversely, with the outer suture being first made with the formation of loops without tightening them, then under the stitches of the external suture with the same thread in the opposite direction, the inner suture is tightened with smaller stitches than outer, and after it is completed, the outer suture is tightened and the ends of the thread are tied ”- is new and provides a double-row suture on the edges of the hernial defect without clipping from the umbilical ring rikreplennoy thereto by scar tissue circumference, the outer seam strengthens inner front and rear.

Symptom: - "the external suture is applied, departing 1.0-1.5 cm from the edges of the hernial defect" - is new and defines the indent from the edges of the hernial defect when applying the external suture.

Symptom: - “the inner suture is applied, departing 0.5-1.0 cm from the edges of the hernial defect” - is new and defines the indent from the edges of the hernial defect when the inner suture is applied.

Symptom: - “at the end of the suture polypropylene thread, a ring of soft polymeric material is attached, through which each loose loop is passed when the outer suture is applied, and after the inner suture is applied, the ring is cut and removed from the wound” - is new and determines the nature of the fixation of the end of the polypropylene thread and loose stitches of the outer seam.

Symptom: “before tightening the outer seam, a polypropylene net rolled up into the roller is laid under its loops on the line of the inner seam, and then the outer seam is tightened” - is new and determines the use of a polypropylene net rolled up into the roller to increase the reliability of plastic.

Five of the nine distinctive features of the proposed method from the prior art are not known. Therefore, the claimed technical solution meets the criterion of "inventive step".

With the interaction of essential features, a new technical result is obtained, namely, an increase in the effectiveness of plastic with umbilical hernias.

The essence of the proposed method is illustrated in FIG. 1 and 2, reflecting the stages of its implementation, where: 1 - hernial sac; 2 - edge of the hernial defect; 3 - aponeurosis; 4 - scar tissue attached to the umbilical ring around its circumference; 5 - subcutaneous fat; 6 - rectus abdominis muscle; 7 - the inner surface of the edge of the hernia gate; 8 - loose outer continuous seam; 9 - tightened inner continuous seam; 10 - the edges of the hernia gate are reduced by an internal continuous suture; 11 - tightened outer continuous seam; 12 - rolled into a roller polypropylene mesh; 13 - a ring of soft polymeric material; 14 - the end of the polypropylene thread fixed to the ring of polymer material.

In FIG. 1A shows the application of a continuous external suture to the edges of a hernial defect without tightening it with the formation of loops. In FIG. 1B, an internal continuous suture is applied and tightened to the edges of the hernial defect. In FIG. 1B, the outer continuous seam is tightened, the ends of the polypropylene thread are interconnected. In FIG. 1G, a ring of soft polymeric material is fixed to the end of the polypropylene yarn. In FIG. 2A, a polypropylene mesh rolled into a roller is laid on an internal continuous seam. In FIG. 2B, the outer seam is tightened over a polypropylene mesh rolled into a roller.

The proposed method of surgery for umbilical hernia is as follows. After processing the surgical field, a skin incision is made in the navel. The bag 1 is isolated, the edges of the hernia gate 2 are cut off from the umbilical ring attached to the circumference of the scar tissue 4. Next, the hernia defect is fixed by applying polypropylene sutures 8, 9 to its edges with the aponeurosis 3 inserted and attached to the umbilical ring around the circumference of the scar tissue 4. Elimination of a hernial defect is performed by a two-row continuous polypropylene suture longitudinally or transversely. First, the outer seam 8 is applied with the formation of loops without tightening them, then under the loops of the outer seam 8 with the same thread in the opposite direction, the inner seam 9 is tightened with finer stitches than the outer one, and after its completion, the outer seam 9 and the ends of the thread 8 are tightened, 9 are connected by a knot 11. In this case, the external suture 8 is applied, departing 1.0-1.5 cm from the edges of the hernial defect. The inner suture 9 is imposed, departing 0.5-1.0 cm from the edges of the hernial defect. At the end of the suture polypropylene thread 8, 9, a ring 13 of soft polymer material is attached, through which, when applying the external suture 8, each loose loop is passed, and after the internal suture 9 is applied, the ring 13 is cut and removed from the wound. With weakness of the aponeurotic tissues 3, 4, as well as with large umbilical hernias, before tightening the external suture 8, lay a polypropylene mesh 12 rolled into a roller under the hinges on the line of the internal suture 9, and then tighten the external suture 8. Finish the operation by suturing the skin.

The essence of the proposed method is illustrated by examples of specific implementations.

Patient K., 30 years old, was in the Department of Surgery with a diagnosis of primary correctable umbilical hernia (medium, hernia gate size 3 cm). The surgical intervention: hernia repair with plastic by the present method. After processing the hernial sac, which was inserted into the abdominal cavity, plastic was made without using a polypropylene mesh. The postoperative period without complications. Pain is negligible. On the 1st day, the patient began to walk. The time spent in the hospital is 7 days. Discharged under the supervision of a polyclinic surgeon. Control examination every 6 months. No complaints, local status without features. When viewed after 2.5 years, no relapse was noted.

Patient M., 82 years old, was in the surgery department with a diagnosis of primary correctable umbilical hernia (large, hernial defect 5 cm). Surgical intervention: hernia repair with plastic by the present method using a roll of polypropylene mesh. The postoperative period was uneventful. Pain is negligible. In the first day, the patient began to walk. The time spent in the hospital is 6 days. Control examination every 6 months. No complaints, local status without features. When viewed after 2 years, no relapse was noted.

A total of 26 patients were operated using the proposed technique. In 4 cases, hernias were irreversible. In 7 cases, a roller made of polypropylene mesh was used for plastic. There were no complications, no relapses with follow-up from 6 months to 2.5 years.

Lintex polypropylene nets were used as a synthetic mesh prosthesis.

Thus, the proposed method can be used in the treatment of primary umbilical hernias. It leads to an increase in the effectiveness of plastic for umbilical hernias.

Claims (5)

1. The method of operation for umbilical hernias, including access through the navel to the hernia in the bag, isolating and processing the latter, exposing the edges of the hernia defect without cutting off the scar tissue attached to it around the circumference, eliminating the hernia defect by applying polypropylene sutures to its edges with suturing aponeurosis and attached to the umbilical ring around the circumference of scar tissue, layer-by-layer suturing of the wound, characterized in that the elimination of the hernial defect is performed by a double-row continuous polypropylene suture rodolno or transversely, at the same time, the outer seam is first imposed with the formation of loops without tightening them, then under the outer seam loops with the same thread in the opposite direction, the inner seam is tightened with finer stitches than the outer one, and after its completion, the outer seam and the ends of the thread are tightened bind. 2. The method according to p. 1, characterized in that the outer suture is applied, departing 1.0-1.5 cm from the edges of the hernial defect. 3. The method according to p. 1, characterized in that the inner suture is applied, departing from 0.5-1.0 cm from the edges of the hernial defect. 4. The method according to p. 1, characterized in that at the end of the suture polypropylene thread is attached a ring of soft polymeric material through which, when applying the external suture, each loose loop is passed, and after the internal suture is applied, the ring is cut and removed from the wound. 5. The method according to p. 1, characterized in that before tightening the outer seam is laid under its loops on the line of the inner seam rolled into a roller polypropylene mesh, and then tighten the outer seam.

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