SU1437007A1 - Method of treatment of ventral hernia - Google Patents

Abstract

The invention relates to medicine, namely to surgery, and can be used in the treatment of giant ventral hernias with a large and complex wall defect. The aim of the invention is to increase the safety of operations, restore the structure and function of the abdominal wall and reduce the number of relapses of the disease. After the separation of two cicatricio-musculoaponeurtic flaps within 5 cm throughout the abdominal wall defect, plasticity is produced more than 2 / 3-3 / 4 of the hernial gate by doubling the abdominal wall with two rows of through P-shaped stitches with reinforcement outside third row on D konovov- Mayo-Sapezhko. After 4-6 weeks, the remaining part is herniated. out gate

Description

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This invention relates to medicine, specifically to surgical methods for closing large and complex defects with the abdominal wall.

The aim of the invention is to increase the safety of the operation and reduce the possibility of recurrent disease — achieved by pr, and treating giant ventral hernias with a large and complex defect of the abdominal wall, the plastic surgery with local tissues is divided into two stages.

The method is carried out in the following way.

After a preliminary compression workout of the abdomen, a wide skin incision and hernial sac are made under the tick for 2–3 weeks. Kra wounds are isolated by wrapping k.h towels. Perform revision. Adhesions are dissected, internal organs are separated from the hernial sac and the anterior abdominal wall. Herniated defect is mobilized to the side in the limit .; 5 cm on; all over. In order to prevent acute pulmonary heart failure due to a sharp increase in intra-abdominal pressure, the intervention is completed with plastic surgery of the large (2 / 3-3 / 4) part of the hernial gate by doubling the abdominal wall with two rows of through U-shaped IIJBOBs with third release r d house on D konovu-Mayo-Sapgzhko. The arid, smaller sector of the hernial ring is closed by doubling the hernia sac that is partially preserved in this zone. The excess of the skin-subcutaneous flap together with the hernia is excised with a vym bag, the wound is sutured. After 4-6 weeks, the second, lighter, completing stage of the operation is performed by means of the abdominal wall doubling.

Example. Patient K., 32 years old, was operated on in April 1982 for a destructive apodimenitis complicated by peritonitis, you were suffering from a low-mean laparotomy. After 5 days - relaparotomy from the xiphoid1 of the appendix to the ulon due to continuing peritonitis. Conducted drainage of the abdominal cavity. Complication - suppuration of the wound, eventration. The elimination of the latter was not carried out due to a pronounced inflammatory process in the wound: ligation was performed. In August 1982, after cleansing the wound, auto-thermoplasty was performed.

In October 1983, the patient was admitted for planned hernia repair. Grigea is gigantic, its circumference is 91 cm, height is 11 cm,

defect size 30X28 cm. Conducted. Intensive preoperative preparation - increasing dosed pneumocompression, exercise therapy, respiratory gymnastics. On November 30, 1983, the first stage of the plastic of the caudal 3/4 parts of the defect was carried out according to the proposed method. It was not possible to perform plastic surgery in one stage because of the pronounced tension of the flaps, especially in the epigastrium, where convergence is almost impossible due to divergence of the muscles to the costal arches, and the subsequent development of acute respiratory insufficiency in the early postoperative period. The cranial part 1/4 of the defect is eliminated only by doubling the scar-modified hernial sac. The operations were complicated by ligature fistulas, the separation of most ligatures. However, hernia recurrence did not occur.

The elimination of the upper quarter of the abdominal wall defect was carried out according to the proposed method, and it was found at the operation that the defect remaining after the first stage was reduced in size by about 2.5 to 3 times. The patient is examined several times after surgery, there is no relapse.

The proposed method allows to predict the development of postoperative pulmonary cardiac complications with large

ventral hernia and recommended for

 actual use.

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Claims (1)

Invention Formula With 10 treatment of ventral hernias, including plastic surgery with local tissues to form a duplicate, characterized in that, in order to increase the safety of the operation and reduce the possibility of disease recurrence with large and complex def, the abdominal wall plastics are divided into two stages In this case, at the first stage, the plastics are performed in the zone of less tension of the tissues and the greater part of the hernia gate is closed, and the remaining defect is temporarily covered with a hernial mecha- num tissue, and the plastic is subsequently produced.