UA122107C2 - METHOD OF ALLOPLASTICS AFTER SURGICAL VENTRAL HERNIATIONS - Google Patents

Abstract

The invention relates to medicine, namely to surgery, and can be used for alloplasty of postoperative ventral hernias, comprising placing a mesh implant under the aponeurosis of the vagina of the rectus abdominis with its fixation with nodal sutures, in which fixation of the mesh implant is carried out through the channels subcutaneously -fat fiber in four or eight fixation points with the imposition of vertical through nodal sutures and their tying at fixation points.

Description

The invention belongs to the field of medicine, namely to surgery, and can be used for surgical treatment of postoperative ventral hernias with the use of mesh alloplasty.

A known method of surgical treatment of postoperative ventral hernias with the use of alloplasty with a mesh under the aponeurosis and fixation of the mesh with a continuous polypropylene thread

E. However, this method has disadvantages, which are that, firstly, the use of a continuous polypropylene thread can lead to displacement or dislocation of the mesh when using non-tensioned alloplasty, when large gaps are created between the tracks of a continuous polypropylene thread with minimal tension of the turns; secondly, dislocation of the mesh with this option of alloplasty may occur due to the lack of anchor points for fixing the edges of the mesh implant to other aponeurotic tissues of the abdominal wall.

The method of alloplasty of postoperative ventral hernias with the placement of a mesh implant under the aponeurosis of the sheath of the rectus abdominis muscle with its fixation at four points and the capture of the aponeurosis with single nodal sutures is the closest to the claimed method, chosen as a prototype. At the same time, this method is not without disadvantages, which consist in the fact that the application of nodal sutures under the aponeurosis when fixing the mesh at four points may not be reliable in connection with the cutting of the seams and the development of dislocation of the mesh implant.

The basis of the invention is the task of developing a method of alloplasty of postoperative ventral hernias by fixing a mesh implant through channels in the subcutaneous fat tissue at four or eight anchor points of fixation with the imposition of vertical through knotted sutures and their tying at the anchor points of fixation, which allows obtaining a new technical result.

The technical result is that the fixation of the mesh implant in four or eight anchor points of fixation with the imposition of vertical through knotted sutures through the channels in the subcutaneous fatty tissue and their tying allows for a strong and reliable fixation of the implant, to prevent the development of dislocation of the mesh implant, to reduce the risk of recurrence of postoperative ventral hernia in the distant postoperative period.

The task is solved by the fact that the method of alloplasty of postoperative ventral hernias includes the placement of a mesh implant under the aponeurosis of the sheath of the rectus abdominis muscle with its fixation with nodal sutures and, according to the invention, fixation of the mesh implant is carried out through channels in the subcutaneous fatty tissue in four or eight supporting fixing points with the imposition of vertical cross-sectional knotted seams and their tying at the supporting fixing points.

A distinctive feature of the claimed method is the fixation of the implant at four or eight anchor points of fixation with vertical through knotted sutures passed through the channels in the subcutaneous fatty tissue, which makes it possible to perform a strong fixation of the mesh implant, to ensure the prevention of dislocation of the mesh implant in the distant postoperative period, to reduce risk of recurrence and improve the results of surgical treatment of postoperative ventral hernias.

The essence of the invention is explained by graphic images, which show the stages of the method of alloplasty of postoperative ventral hernias: in fig. 1 - supporting points of fixation of the mesh implant - four; in fig. 2 - support points of mesh implant fixation - eight; in fig. C - the location of the mesh implant under the aponeurosis of the vagina of the rectus abdominis muscle; the implementation of channels in the subcutaneous fatty tissue at the support points of fixation, four or eight, with the execution of vertical through knotted sutures at the supporting points of fixation through the channels in the subcutaneous fatty tissue; in fig. 4 - tying of nodal vertical through seams, passed through the channels in the subcutaneous fatty tissue at the anchor points of the implant fixation.

At the same time, the following are marked: 1-4, 5-8 - anchor points of fixation; 9 - mesh implant; 10 - aponeurosis of the vagina of the rectus abdominis muscle; 11 - rectus abdominis muscle; 12 - channels in subcutaneous adipose tissue; 13 - vertical cross-sectional nodal seams applied at the support points of fixation; 14 - tied vertical knot seams.

The method is carried out as follows.

After removal of the old postoperative scar, dissection and separation of the hernia sac, the remainder of the peritoneum of the hernia sac is excised, the peritoneum is separated from the muscle

of the aponeurotic flap of the abdominal wall on the right and left, the peritoneum is sutured, four fixation points (1-4) are marked (Fig. 1) or between the previous four fixation points (1-4) four more intermediate fixation points (5-8) are marked to create eight anchor points of fixation (Fig. 2), place the mesh implant (9) under the sheath aponeurosis of the rectus abdominis muscle (10) and behind the rectus abdominis muscle (11); then channels are formed in the subcutaneous adipose tissue (12) at the anchor points of fixation, four (1-4) or eight (1-8), after that, vertical cross knotted sutures (13) are made through the channels in the subcutaneous adipose tissue (12) with the capture of the edge of the mesh implant (9) in the support points of fixation (1-4) or (1-8) (Fig. 3); vertical knotted sutures (14) are tied in the subcutaneous channels at the anchoring points (Fig. 4), the front sheet of the aponeurosis of the vagina of the rectus abdominis muscles is sutured along the midline with a continuous atraumatic polypropylene thread, and a subaponeurotic tubular vacuum drainage is left.

A specific example of the method. 1. Patient R., 60 years old, ii. min. Mo 2417, was admitted to the clinic on February 12, 2018 with a diagnosis of postoperative ventral hernia, uterine leiomyoma. History: in 1995 - cholecystectomy, relaparotomy due to intra-abdominal bleeding. Hernia protrusion appeared 1 year after surgery. 15.02.18 operation: allogeneoplasty "500 Iau", myomectomy. A 45 cm long postoperative scar was excised with two semi-oval incisions, and hernia sacs (8x8 cm; 6xhb cm; 6xhb cm; 5x5 cm) were identified, which were found along the course of the postoperative scar. The remaining peritoneum is excised. The scarred omentum protruding into the hernia sac was resected. During the revision of the small pelvis, a 3x3 cm fibromatous node on the leg was found at the bottom of the uterus. A conservative myomectomy with a suture was performed (mustu! 3/0). Hemostasis. After opening the sheath of the rectus abdominis muscles, fascial-peritoneal flaps are formed, which are sewn with a prolene thread; then polypropylene mesh Rgtoteb5P, 40x25 cm in size, is located retromuscularly "51tsb Iau". Formed channels in the subcutaneous adipose tissue at 8 anchor points of fixation, after that, vertical cross knotted sutures were made through the channels in the subcutaneous adipose tissue with capture of the edge of the mesh implant at the 8 anchor points of fixation with subsequent tying and additional fixation continuous along the perimeter of the implant

With prolene thread (2/0). The subaponeurotic space is drained with vacuum perforated drainage. The edges of the aponeurosis are sewn with a ROBI1 thread - a loop. The subcutaneous tissue is also drained by vacuum perforated drainage. Stitches on the wound in layers. Aseptic bandage. On the 11th day after the operation, she was discharged in a satisfactory condition for outpatient treatment. Examined after 1 year and 3 months, there is no recurrence of the hernia.

The method was used in 38 patients with postoperative ventral hernias. The method makes it possible to carry out radical hernia surgery, reliably strengthen the abdominal wall, prevent dislocation syndrome for the implant, and prevent the recurrence of postoperative ventral hernia. Out of 38 patients, hernia relapse occurred in one patient a year after surgery when using the alloplasty method using a mesh implant.

The method can be applied in the practice of surgical departments of district hospitals, city, regional hospitals, herniological centers, centers of plastic surgery, centers of reconstructive surgery of the anterior abdominal wall.

Sources of information: 1. Toskin K.D., Zhebrovsky V.V. Abdominal hernias. - M.: "Medicine", 1983. -240 p. 2. Zhebrovsky V.V., Mylchenko F.N. Atlas of operations for abdominal hernias. -Simferopol, 2004, - 315 p.

Claims (1)

FORMULA OF THE INVENTION The method of alloplasty of postoperative ventral hernias, which includes the placement of a mesh implant under the aponeurosis of the sheath of the rectus abdominis muscle with its fixation with knotted sutures, which is characterized by the fact that the fixation of the mesh implant is carried out through channels in the subcutaneous fat tissue in four or eight anchor points of fixation with overlapping vertical through knotted seams and tying them at the supporting points of fixation.