SU1069786A1 - Method of treatment of patients ill with ventral hernia - Google Patents

Abstract

METHOD FOR TREATMENT OF LARGE-ventral hernia, comprising the selection of the hernial sac and fascia defect and stitching edges of aphid and h and w and u and so -that the purpose of preventing recurrence of hernias vvdeleni after hernia sac and aponeurosis, the hernial sac is dissected, cut the patches on the feeding leg in a staggered order, then cuts are made in the muscular apone, in the optic layer opposite each of the patches, then the patches are made through the incisions and after sewing the musculo aponeurotic layer, patches are laid over the seams ruyut hjc, kaponevrozu the perimeter sutures. O) from 00 O)

Description

The invention relates to medicine, specifically abdominal surgery, and may be used in the surgical treatment of extensive abdominal wall hernias.

A known method for the treatment of large ventral hernias involves the isolation of a hernial sac and aponeurosis and the subsequent autoplastic shelter of the hernial ring, according to which the hernial sac and aponeurosis are separated. The hernial sac is excised and the margins of the defect are stitched with one or two rows of stitches or, if tissue is allowed, in the form of duplicate G1.

The disadvantage of this method is the recurrence of the hernia due to the fact that this method is not always executable, because due to the tension of the tissues only one row of stitches is removed.

The purpose of the invention is the prevention of hernia recurrence.

The goal is achieved by the fact that according to the method of treating large central graves, including the isolation of a hernia bag and aponeurosis with subsequent folding of the edges of the defect, the hernial bag is dissected, cut in a staggered pattern on the stump of the pedicle, then cuts are made in aphalop-aph-aph-aph-aph-aph-aph-aphropodic-aphropodic-aphropodic-aphoric-aphoric-aphoric-aphoric-flap on the stump leg, then cuts are made in the aphrasy-aph-aph-aphic-aphrophaloptic-aphrodis-aphrophic-apneurosis; each flap, then flaps are passed through the incisions and, after stitching the muscular aponeurotic layer, flaps are laid over the sutures and fixed, then they are sewn into the aponeurosis along the perimeter by separate sutures.

FIG. 1 shows the initial stage of the operation of the proposed method; in fig. .2 - establishment of strips in cuts in the muscular aponeurotic layer; in fig. 3 - crosslinked muscular aponeurotic layer / ca of FIG. 4 - the final stage of the operation.

The proposed method is carried out in the following manner.

Cut the skin, subcutaneous tissue box 1, expose the hernial sac, and release the aponeurosis 2 (Fig. 1 |. The hernial sac is cut into two parts and cut out of it, in checkerboard pattern, counter strips 3 and 4 on the 3-4-meter feeding stem. Stripes cut in the transverse direction with respect to the longitudinal axis of the hernia, according to the location of the future muscular aponeurotic sutures. Cuts 5 and 6 are made in the musculoaponeal Tropical layer opposite each strip 3-5 cm from the edge of the rye bag. they were broken through cuts for aponeurosis (Fig. 2) .. The sheath-aponeurotic layer is stitched in one row

stitches (Fig. 3), the strips are laid over the stitches on one's side and fixed along the perimeter of the aponeurosis with individual interrupted stitches (Fig. 4).

Example. Sick 76 years. Diagnosis: large postoperative ventral hernia after appendectomy. Hernia size is 30-15 cm.

Operation description. Prd endotracheal anesthesia excised postoperative scar. A hernial sac of 25–15 cm with several cavities was isolated. Around the hernial sac, an aponeurosis is allocated up to 5 cm wide. The hernial sac is opened in the longitudinal direction, the small and large intestine loops attached to it are separated. From the hernial sac, counter flaps of up to 5 cm wide, up to 10 cm long, four flaps on each side were cut out. The indentations from the edge of the defect 4–5 cm in the kyshechno-aponeurotic layer are made through openings 2-2.5 cm long, parallel to the aponeurotic edge, respectively, to the counter flap. Through these cuts were made from the side of the strip of strip the cut out pieces. One row of interrupted sutures sewed the edges of the musculoaponeurogy. The grafts of the hernial sac are laid over the sutures on their side and fixed to the perimeter with interrupted sutures. Wounds are sutured, scabs are held. The seams on the fascia, skin.

Postoperative treatment is smooth. She was discharged on the 14th day after surgery.

Example. Sick € 4 years, was admitted for postoperative hernia a year after cholecystectomy and pancreatic resection. When viewed from a patient in the right hypochondrium along the old postoperative scar in the projection of the rectus abdominis muscle, the swelling is 123 cm with a defect in the aponeurosis of 10–5 cm. Concomitant disease; hypertensive disease.

Surgery: hernia repair, abdominal wall plasty according to the proposed method.

Under endotracheal anesthesia with breathing control by two semi-oval cuts, a scar is cut in the area of hernia in the chest. The hernial sac is isolated and the aponeurosis around it. The defect in the G2 aponeurosis is 8 cm. Three flaps with a 4–10 cm pedicle size were cut out of the hernial sac (two of them along the upper edge of the hernial ring and one along the lower edge). On the opposite side of the aponeurosis cut out from the cut-off flaps, 3-4 cm from the edge of the hernial ring are made a 2-cm-long aponeurosis cut through which the peritoneum

Carved out the flaps. The hernial ring sutured in one row of interrupted sutures. The grafts of the hernial sac are thrown over to their side and fixed along the perimeter to the aponeurosis. Separate sutures sutured incisions in the aponeurosis. Stitches on the skin. The patient was discharged in a satisfactory condition after 2i days.

Example. Sick 61 years old, was admitted about recurrent umbilical hernia.

Previously operated on for umbilical hernia, and twice for the recurrence of umbilical hernia.

At the time of inspection, the size of recurrent gray is 15–20 cm. Defect in aponeurosis 10-O, see.

Surgery: hernia repair, biliary wall plastic with the use of a hernia sac flap.

Under endotracheal anesthesia with muscle relaxants two semi-oval cuts in the transverse direction, a skin flap 20 & see a hernial sac of 20–15 cm with a defect in the aponeurosis of 10–8 cm isolated. From the hernial sac, flaps measuring 4 x 10 cm in size (two along the upper and two along the lower, edge of the hernial gate) are found. 3-4 cm from the edge of the hernial gate cuts 2–2 cm long are made in front of the cut flaps in the aponeurosis, all of which are made from the peritoneum, broken flaps. The hernial gate is sutured with one row of nodal stitches. The flaps from the hernia sac are spread to one side and fixed along the perimeter to the aponeurosis with separate WelmiElmi stitches. The seams on the subcutaneous tissue and skin . The smooth postoperative course. Sick started walking on the 7th day.

Discharged after 12 days in a satisfactory condition for outpatient treatment.

With the proposed method of treating large ventral hernias, two additional layers of the abdominal wall are created, which resist intra-abdominal pressure, which increases the density of the hernia gate. The voltage is removed from

0 muscle-aponeurotic seams, which contributes to their better healing of hernia recurrence. Hernial jersey strips are resistant to infections and the millimetal aponeurotic sutures are closed to prevent suppuration. Taking into account the strength of the plastic wall, the patients rise on the 5-6th day after the operation instead of 10-15 days, which reduces the possibility of thromboembolic complications and expands the ability to combat postoperative pneumonia. The terms of hospital stay in the postoperative period are reduced to two weeks.

The proposed method makes it possible to create two additional layers of the abdominal wall due to the cut bands that strengthen the zone of muscle-aponeurotic sutures, relieve tensile stress from them, thereby promoting their better healing and prevent the recurrence of the hernia, and also avoid complex types

5 plasty of the abdominal wall (movement of the fascia of the thigh, alloplasty},

The proposed method can be recommended for introduction into surgical practice as a more reliable and simple method for treating large ventral hernias.

Fi.Z

Claims (1)

METHOD FOR TREATING LARGE-VENTRAL HERNIA, including the isolation of a hernial sac and aponeurosis followed by suturing of the edges of the defect, and with the fact that, in order to prevent recurrence of hernias after isolation of the hernial sac and aponeurosis, the hernial sac Dissect, cut in a checkerboard pattern Flaps on the feeding leg, then make incisions in the muscle-aponeurotic layer opposite each flap, then carry out the flaps through the incisions and, after stitching the muscle-aponeurotic layer, flaps are laid over the joints and fix b, to the 'aponeurosis along the perimeter of individual shvamts. Figure 1 <x> m oo>