RU2697058C1 - Method of postoperative seroma treatment in patients with ventral hernias - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: what is presented is a method of postoperative serum treatment in patients with ventral hernia involving puncture of seroma cavity with sterile syringe, evacuation of serous fluid. Puncture needle is not withdrawn and 1 ml of diprospan is introduced once more into the seroma cavity, and an aseptic dressing is applied on the wound.

EFFECT: better postoperative treatment of postoperative seroma in the patients with ventral hernias.

1 cl, 2 dwg

Description

The invention relates to medicine, in particular to surgery, and can be used for the treatment of seromas in the postoperative period in patients with ventral hernias.

Seroma is one of the most common early postoperative complications of hernia repair. The substrate of this pathology is the accumulation of serous fluid in the area of the surgical wound. Recently, due to the popularization of non-tight methods of hernioplasty, and the use of synthetic mesh prostheses, the number of early postoperative complications has increased markedly and according to some authors reaches 40%. In turn, all complications require treatment, which extends the patient's hospital stay and rehabilitation period, as well as worsens the results of surgical treatment of patients with ventral hernias.

There are many ways to treat this complication, from the elimination of the wound cavity in the area of surgical intervention to the introduction of various substances into the cavity of an already formed seroma. None of the currently existing methods, in our opinion, is quite effective.

A known method of stopping seroma by puncture. This is an ordinary syringe with a needle. The disadvantage of this method is its frequent low efficiency, which forces to resort to repeated puncture or drainage of the cavity. (V.N. Egiev, “Hernias” Moscow, Medpraktika, 2015, p. 38-40).

Various types of tubular drains are known that are installed on the bottom of the wound. The disadvantage of this method is that when the tube is in the wound, infection of the wound discharge is possible with subsequent suppuration, in addition, the drainage tube being a foreign body contributes to the exudation of wound fluid. (V.N. Egiev, “Hernias.” Moscow, Medpraktika, 2015, p. 41-43).

One of the significant drawbacks of most methods of treatment of postoperative seromas used today is the lack of consideration of the physiological and humoral aspects of the state of the postoperative wound. When dissecting and separating subcutaneous fat, as well as coagulating it with the goal of hemostasis, an extensive wound surface appears, which begins to produce a large amount of exudate. As a result, early retention complications develop. All this leads to prolonged wound healing and an increased risk of infection and worsening of the results of surgical treatment.

The closest method for treating seromas is the method of Seredin Sergey Alexandrovich patent No. 2360618 which consists in the following: a method for treating seroma, including the evacuation of serous fluid, characterized in that if the concentration of microbial bodies in serous fluid is determined to critical values of 105-106 CFU to serous fluid a single, maximum permissible dose of a broad-spectrum antibiotic is added, dissolved in a sterile vessel and injected into the serum cavity.

However, this method has its drawbacks:

-the need for bacteriological studies obtained by means of puncture fluid;

- broad-spectrum antibiotics do not prevent tissue exudation in the wound;

- repeated trauma to the tissues with a puncture needle supports the inflammatory process;

- dead microbial bodies can act on the wound surface with endotoxins and enhance exudation.

The alleged invention is aimed at improving the results of treatment of seromas in the postoperative period in patients with ventral hernias.

The specified technical result is achieved in the invention by the fact that the puncture needle is not removed and 1 ml of diprospan is injected into the serum cavity once and an aseptic dressing is applied to the wound.

Due to the fact that patients with ventral hernias undergo mobilization of subcutaneous fat in preparation for hernioplasty, an extensive wound surface is formed that actively produces serous exudate. When using non-tight methods of hernioplasty, the above factor is supplemented by a response exudative reaction of the body to the mesh explant. In the postoperative period, if the patient shows signs of seroma (swelling, fluctuation, secretion of serous discharge), a seroma cavity is punctured with a sterile syringe, the serous fluid is evacuated, the puncture needle is not removed, and 1 ml of diprospan is injected into the serum cavity once, then put on the wound aseptic dressing.

The drug Diprospan belongs to the group of glucocorticosteroids. It has a pronounced anti-inflammatory effect. It has an inhibitory effect on the release of interleukins 2 and 1, macrophages and gamma interferon from lymphocytes, as well as inflammatory mediators from eosinophils. It induces the formation of lipocortins, lowers the metabolism of arachidonic acid. Given that with alloplasty of hernial defects with synthetic mesh explants, active exudative inflammation occurs due to tissue trauma and implantation of a foreign body into the wound, this drug creates the prerequisites for reducing the severity of local inflammatory reactions. Accelerating thereby regenerative processes in the wound and reducing the frequency of wound complications. The active substances of this drug: betamethasone disodium phosphate (2 mg) and betamethasone dipropionate (5 mg). For 1 ml of a solution of 2 and 5 mg, respectively. Betamethasone sodium phosphate undergoes hydrolysis well quickly, is immediately absorbed, which provides a quick therapeutic effect. Betamethasone dipropionate is slowly absorbed, metabolized gradually, which leads to a long-term effect of the drug for more than 10 days, which is enough to stop expressed postoperative inflammatory reactions in the wound and its faster healing.

This method of treatment of seromas, in addition to stopping active exudative processes in a postoperative wound, provides a general anti-inflammatory effect.

The 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 14 patients. Below are the results of testing.

Example No. 1

Patient G., 48 years old, was admitted to the medical institution NUZ Department Hospital at the station. Astrakhan-1 JSC Russian Railways with a diagnosis of Postoperative ventral hernia.

11/23/2017 - under endotracheal anesthesia, hernia repair was performed with plastic polypropylene mesh according to the onlay technique. On the 2nd day after the operation, the patient has clinically determined seroma of the postoperative wound. The seroma cavity was punctured with a sterile syringe, 7 ml of serous fluid was evacuated, then without removing the puncture needle, 1 ml of diprospan was once introduced into the seroma cavity. An aseptic dressing is applied.

Data for the recurrence of seroma in the postoperative period was not received. The patient was discharged on the 9th day.

Example No. 2

Patient L. 54 years old, was admitted to the medical institution NUZ Department Hospital at the station. Astrakhan-1 JSC Russian Railways with a diagnosis of Postoperative ventral hernia.

11.29.2017 - under endotracheal anesthesia, hernia repair was performed with plastic polypropylene mesh according to the inlay technique. On the 3rd day after the operation, the patient has clinically determined seroma of the postoperative wound. The seroma cavity was punctured with a sterile syringe, 5 ml of serous fluid was evacuated, then without removing the puncture needle, 1 ml of diprospan was once introduced into the seroma cavity. An aseptic dressing is applied.

Data for the recurrence of seroma in the postoperative period was not received. The patient was discharged on the 8th day.

The proposed method achieves an improvement in the results of surgical treatment of ventral hernias, namely:

- reduction in the number of relapses of retention complications;

- reduction in the frequency of infectious complications;

- acceleration of regenerative processes in the wound;

- improving the quality of life of patients in the postoperative period; These features of the method are conditions that improve both the processes of tissue regeneration in the plastic field and the results of surgical treatment 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 treating seromas in the postoperative period in patients with ventral hernias, including puncture of the seroma cavity with a sterile syringe, evacuation of serous fluid, characterized in that the puncture needle is not removed and 1 ml of diprospan is injected into the serum cavity once and an aseptic dressing is applied to the wound.