RU2665130C1 - Method of surgical treatment of diastasis of rectus abdominis muscle 1-2 degrees - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely, to surgery of treatment for diastases of the rectus abdominis muscles. After dissection of the skin, subcutaneous tissue, isolation and dissection of the aponeurosis of the white abdominal line of the vagina of the rectus abdominal muscles, open the diastase at the medial edge along the entire length. Next, mesh prostheses are used in the form of rectangular plates 6–8 cm wide, the length of which corresponds to the extent of diastase. And one plate has two cut on the long side of the petal, and the second – one cut out the petal width of 5–7 cm and a length of 6–8 cm. Then the mesh prosthesis is fixed with sutures to the posterior surfaces of the vagina of the rectus abdominis muscles, and the petals of each prosthesis are fixed to the back surface of the anterior leaf of the vagina of the rectus abdominum on the opposite side, forming a "lock" type cross. Front sheets of the vagina of the rectus abdominals are stitched together, forming a white belly line. Drain the subcutaneous tissue and layer-by-layer suture the wound.EFFECT: method restores the white belly line, strengthens the anterior abdominal wall and allows preserving its anatomical and physiological function.1 cl, 4 dwg, 3 ex

Description

The invention relates to medicine, namely surgery, and can be used in surgical treatment for diastasis of the rectus abdominis muscles.

The problem of surgical treatment of diastasis of the rectus abdominis muscles remains very relevant despite the many methods and methods for its elimination. Analyzing the nearly half-century history of rectal diastasis surgery, all methods can be conditionally divided into 4 groups: 1) intraperitoneal (method of V.P. Voznesensky, method of A.A. Troitsky, method of A.V. Martynov); 2) extraperitoneal (Champion's method); 3) with the opening of the vagina of the rectus abdominis muscles (method of N.I. Napalkov); 4) using mesh synthetic prostheses (method S.V. Vasiliev, method A.Yu. Teterin). The search for ways to improve the results of surgical correction of diastasis of the rectus abdominis muscles indicates the dissatisfaction of surgeons with the existing methods of surgical treatment of this nosology. This is due to the fact that during surgical treatment of patients with primary diastasis of the rectus abdominis, relapse reaches 26%, and after repeated operations - up to 63.7% [Askerkhanov RP, Barkov B.A., Zhebrovsky V.V.] .

In recent decades, for the surgical correction of rectal diastasis diastasis, synthetic polypropylene prostheses are used, which are fixed for aponeurosis without suturing the last “onlay” (Kockerling method), as well as endoscopic methods of plastic surgery using a mesh prosthesis (laparoscopic rectal diastasis removal using the technique plications of the type "blinds").

One of the significant drawbacks of most of the lightweight methods used today to eliminate diastasis of the rectus abdominis is the lack of consideration of the biomechanical and topographic anatomical aspects of the state of the anterior abdominal wall. All this leads to the shutdown of the anterior abdominal wall from the physiological mechanisms of the act of breathing.

The closest method of surgical treatment for diastases of the rectus abdominis to the method proposed by us is the method of treating diastasis of the rectus abdominis Vasilyeva, T.A. Moshkova, V.V. Oleynik (patent No. 2238991 dated July 20, 2008). This method of treating diastasis of the rectus abdominis muscles consists in isolating and opening the leaves of the vaginas of both rectus abdominis muscles at their inner edges, suturing the posterior leaves of the vaginas, suturing to them a mesh prosthesis and differs in that they use a prosthesis in the form of a rectangular plate 6-10 cm wide, equipped with fixing tapes 2-2.5 cm wide, evenly spaced 3-4 cm from each other on both sides of the plate along its entire length, corresponding to the length of the diastasis, the prosthesis is placed on stitched back sheets u of the rectus muscles, fix it along the midline to the previously applied sutures of the posterior sheaths of the rectus muscles, then grasp the rectus muscles with ribbons, bring them to the middle position and fix the ribbons on the plate to the previously applied seams, sew the anterior sheaths of the rectus rectus muscles and suture them in layers the wound.

However, this method has several disadvantages that affect the occurrence of relapse and violation of the physiological properties of the anterior abdominal wall:

- laying of polypropylene prosthesis tapes around the rectus abdominis muscle will lead to atrophic and cicatricial changes in the muscles, which in turn will worsen the anatomical and physiological functions of the anterior abdominal wall, which can cause relapses;

- insufficiently reliable fixation of tapes to previously applied seams;

- with the circular excretion of the rectus abdominis muscles, injury to the epigastric vessels and their branches is possible, which will lead to the formation of a hematoma;

- the complexity of technical performance.

The present invention is aimed at improving the results of surgical treatment for diastases of rectus muscles of the abdomen of 1-2 degrees. The specified technical result is achieved in the invention by the fact that two mesh prostheses are cut out of one sheet of polypropylene mesh in the form of rectangular plates 6-8 cm wide, the length of which corresponds to the length of the diastasis, with one plate having two cuts along the long side of the lobe, and the second one cut out the petal is 5-7 cm wide and 6-8 cm long, then mesh prostheses are fixed with interrupted sutures to the posterior surfaces of the vagina of the rectus abdominis muscles, and the petals of each prosthesis are fixed to the posterior surface of the anterior sheet the vagina of the rectus abdominis muscle on the opposite side, forming a cross according to the type of “lock”, after which the anterior sheets of the rectus sheaths of the abdomen are sutured together by interrupted sutures, forming a white line of the abdomen, then the subcutaneous tissue is drained and the wound is sutured in layers.

The proposed method of surgical treatment for diastases of the rectus abdominis muscles, in addition to reconstruction of the anterior abdominal wall, provides for the restoration of the full function of the anterior abdominal wall and allows it to effectively participate in the breathing process.

The essence of the invention is illustrated by drawings, where:

- FIG. 1 - isolation and dissection of the aponeurosis of the rectus abdominis muscles with the opening of the vaginas of the rectus abdominis muscles at their medial edge;

- FIG. 2 - fixation to the back surface of the vaginas of the rectus abdominis muscles of the mesh prostheses of the original form, with the subsequent approximation of the edges of the rectus abdominis muscles;

- FIG. 3 - hemming petals of mesh prostheses with interrupted sutures to the posterior surface of the anterior sheet of the opposite vagina of the rectus abdominis muscle with a cross of petals of mesh prostheses according to the “lock” type;

- FIG. 4 - stitching together the front sheets of the vagina of the rectus abdominis muscle with interrupted sutures with the formation of a white line of the abdomen, the final form of plastic.

Our proposed method has been successfully tested in the surgical department of the NUZ Department Hospital at the station. Astrakhan-1 of JSC Russian Railways in 8 patients. Below are the results of testing.

Example 1

A 54-year-old patient M. was admitted to the hospital NUZ Department Hospital at the station. Astrakhan-1 JSC "Russian Railways" with a diagnosis of Diastasis of the rectus abdominis 1-2 tbsp.

06/18/2014 - under endotracheal anesthesia, an incision was made in the skin, subcutaneous tissue along the white line of the abdomen from the xiphoid process to the navel. Diastasis of the rectus abdominis muscles was 4 cm, its length was 18 cm. After dissection of the aponeurosis of the white line of the abdomen, the vagina of the rectus abdominis was opened at the medial edge along the entire length of the diastasis, bluntly, the rectus abdominis muscle was weakened from the anterior leaf of the vagina of the rectus abdominis muscle. Mesh prostheses 18 cm long and 7 cm wide with petals 6 cm wide and 7 cm long cut out along the long side are fixed with interrupted sutures to the posterior surfaces of the rectus sheaths, the edges of the aponeurosis are flattened, and the petals of each prosthesis are fixed to the posterior surface of the anterior leaf of the rectus sheath the abdomen on the opposite side, forming a cross according to the type of “lock”, after which the front sheets of the vaginas of the rectus abdominis muscle are sewn together by interrupted sutures, a white line of the abdomen is formed. Hemostasis. Subcutaneous fat drainage. Layered stitches on the wound.

The patient is allowed to get up on the second day. Drainage removed on the 3rd day. During the control examinations after 4 months, 1 year, 2 years there is no pain, there are no signs of relapse, the function of the anterior abdominal wall is not impaired.

Example 2

Patient S., 58 years old, was admitted to the hospital NUZ Department Hospital at the station. Astrakhan-1 JSC Russian Railways with a diagnosis of Diastasis of the rectus abdominis 2 tbsp.

09/08/14, - under endotracheal anesthesia, an incision was made in the skin, subcutaneous tissue along the white line of the abdomen from the xiphoid process to the navel. Diastasis of the rectus abdominis muscles was 6 cm, its length was 20 cm. After dissection of the aponeurosis of the white line of the abdomen, the vagina of the rectus abdominis was opened at the medial edge along the entire length of the diastasis, bluntly, the rectus abdominis muscle was left from the anterior leaf of the vagina of the rectus abdominis muscle. Mesh prostheses 20 cm long and 8 cm wide with petals 7 cm wide and 8 cm long cut out along the long side are fixed with interrupted sutures to the posterior surfaces of the rectus sheaths, the edges of the aponeurosis are flattened, and the petals of each prosthesis are fixed to the posterior surface of the anterior sheet of the rectus sheath the abdomen on the opposite side, forming a cross according to the type of “lock”, after which the front sheets of the vaginas of the rectus abdominis muscle are sewn together by interrupted sutures, a white line of the abdomen is formed. Hemostasis. Subcutaneous fat drainage. Layered stitches on the wound.

The patient is allowed to get up for 2 days. Drainage removed on the 3rd day. During follow-up examinations in a month, three months, 1 year, 2 years there is no pain, there are no signs of relapse.

Example 3

Patient K., 63 years old, was admitted to the hospital NUZ Department Hospital at the station. Astrakhan-1 JSC Russian Railways with a diagnosis of Diastasis of the rectus abdominis 1 tbsp.

12/11/14, under endotracheal anesthesia, an incision was made in the skin, subcutaneous tissue along the white line of the abdomen from the xiphoid process to the navel. Diastasis of the rectus abdominis muscles was 3 cm, its length was 17 cm.After cutting the aponeurosis of the white line of the abdomen, the vagina of the rectus abdominis was opened at the medial edge along the entire length of the diastasis, bluntly, the rectus abdominis muscle was wound from the anterior leaf of the vagina of the rectus abdominis muscle. Mesh prostheses 17 cm long and 6 cm wide with petals 6 cm wide and 6 cm long cut out along the long side are fixed with interrupted sutures to the posterior surfaces of the rectus sheaths, the aponeurosis edges are flattened, and the petals of each prosthesis are fixed to the posterior surface of the anterior sheath of the rectus sheath the abdomen on the opposite side, forming a cross according to the type of “lock”, after which the front sheets of the vaginas of the rectus abdominis muscle are sewn together by interrupted sutures, a white line of the abdomen is formed. Hemostasis. Subcutaneous fat drainage. Layered stitches on the wound.

The patient is allowed to get up for 2 days. Drainage removed on the 3rd day. During follow-up examinations in a month, three months, 1 year of pain, there are no signs of relapse.

The proposed method improves the results of surgical treatment for diastases of the rectus abdominis muscles of the 1-2 degree, namely:

- restoration of the white line of the abdomen;

- restoration of the full function of the anterior abdominal wall;

- reduction in relapse rate;

- improving the quality of life of patients with diastases of the rectus abdominis muscles.

These features of the operation are the conditions that improve both the processes of tissue regeneration in the plastic field and the results of the operation as a whole, helping to reduce the risk of postoperative complications and improve the quality of life of patients.

The developed method can be widely used in the practical work of surgical departments.

Claims (1)

A method for surgical treatment of diastasis of rectus abdominis muscles of the 1-2 degree, including dissection of the skin, subcutaneous tissue, isolation and dissection of the aponeurosis of the white line of the abdomen, after which the vagina of the rectus abdominis is opened at the medial edge along the entire length of the diastasis with further use of mesh prostheses, characterized in that two mesh prostheses are cut out of one sheet of polypropylene mesh in the form of rectangular plates 6-8 cm wide, the length of which corresponds to the length of the diastasis, and one plate has two in cut along the long side of the petal, and the second is one cut petal 5-7 cm wide and 6-8 cm long, then mesh prostheses are fixed with interrupted sutures to the posterior surfaces of the vagina of the rectus abdominis muscles, and the petals of each prosthesis are fixed to the posterior surface of the anterior leaf of the vagina abdominal muscles on the opposite side, forming a cross according to the type of “lock”, after which the front leaves of the vaginas of the rectus abdominis are sutured together with interrupted sutures, forming a white line of the abdomen, then drain subcutaneous tissue and sutured in layers are wound.

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