RU2306875C1 - Method for hernial plasty of anterior abdominal wall at small-sized hernial portae - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: it is necessary to dissect anterior abdominal wall above hernial protrusion, isolate and set hernial sac into abdominal cavity, separate aponeurosis for about 3-4 cm along the circumference of hernial porta from inside, apply the prosthesis under aponeurosis into prepared bed in preperitoneal fiber, suture the prosthesis in the center with two cruciform sutures, suture aponeurosis at the distance of 1-2 cm against the edges of hernial portae with both ends of the sutures, tighten the sutures above hernial portae sutured with purse-string suture. The innovation enables to increase the strength in prosthesis fixation.

EFFECT: higher efficiency of plasty.

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Description

The invention relates to medicine, namely to surgery, and can be used when performing plastic surgery of hernias of the anterior abdominal wall with small sizes of hernial gates.

Many surgeons have proved that the best results of alloplasty of hernias of the anterior abdominal wall are achieved when the prosthesis is placed under an aponeurosis.

There is a method of plasticity of hernias of the anterior abdominal wall with small sizes of hernial gates, which consists in the fact that with hernial gates of 2-2.5 cm or more, the authors separate the aponeurosis by 2.5-3 cm around the circumference of the hernial gate from the outside and from the inside. The hernial sac, without opening, is inserted into the abdominal cavity. The prosthesis is placed under the aponeurosis and is fixed with 6-8 interrupted sutures along the perimeter. Hernial gates suture edge to edge over the prosthesis (Darwin VV, Zhdanovsky VV Non-tensioning hernioplasty in the treatment of inguinal and umbilical hernias on an outpatient basis. // Bulletin of herniology. - Moscow. - 2004. - P.36-41) . The described method is adopted by the authors as a prototype.

The disadvantages of the prototype are as follows: fixation of the explants under the aponeurosis is accompanied by significant technical difficulties with small sizes of hernial gates and therefore it is not always possible to implant a prosthesis of sufficient size; the need to allocate aponeurosis not only from the peritoneum, but also from the subcutaneous fatty tissue for 3-4 cm along the perimeter of the hernia gate and, thus, the formation of a significant wound size, which increases the risk of postoperative wound complications.

The technical result of the claimed method for plastic surgery of hernias of the anterior abdominal wall with small sizes of hernial gates consists in the possibility of placing the prosthesis of any necessary (adequate) size without the need for skeletonization of the aponeurosis around the hernial gate from the side of the subcutaneous tissue.

The essence of the invention is to achieve the specified technical result in a method comprising cutting an anterior abdominal wall above a hernial protrusion, isolating and decreasing an aponeurosis by 3-4 cm around the circumference of the hernia gate from the inside, placing the prosthesis under an aponeurosis in the prepared for it bed in preperitoneal tissue, in which according to the invention the placed prosthesis is stitched in the center with two cruciform sutures, both ends of which are stitched with aponeurosis at a distance Research Institute 1-2 cm from the edges of the hernial ring and knotted over said stitched seams purse string suture hernial ring.

Clinical studies conducted during the development of the claimed method confirmed the possibility of placing the prosthesis of any required size, even with very small sizes (less than 2.5 cm) of the hernial portal, without the need for skeletal aponeurosis around the hernial portal from the subcutaneous tissue.

The invention is illustrated in the drawing, which shows a diagram of the operation.

The method is carried out, for example, as follows.

An incision is made of the anterior abdominal wall above the hernial protrusion. A hernial sac is isolated. Aponeurosis 1 is distinguished from the side of the abdominal cavity around the perimeter of the hernia gate 2 for 3-4 cm. The hernia sac is guided without opening it into the abdominal cavity. The prosthesis 3 is sutured in the center with two cruciform sutures 4. The prosthesis 3 is placed under the aponeurosis 1 in the bed prepared for it in the preperitoneal tissue so that the ends of the cruciform sutures 4, superimposed in the center of the prosthesis 3, are facing outward (towards the aponeurosis 1). Sew in four places with the free ends of the cruciform sutures 4 of the aponeurosis 1 at a distance of 1-2 cm from the hernia gate 2 also in a mutually perpendicular direction. Impose a purse string suture 5 on the hernia gate 2 and tie this purse string suture 5 over the prosthesis 3. Tie previously placed in the center of the prosthesis 3 and on the aponeurosis 1, step 1-2 cm from the hernia gate, cruciform sutures 4.

The method is illustrated by the following clinical examples.

Example 1. Patient B., 75 years old, was hospitalized as planned. A year ago, after a physical exertion, a hernial protrusion appeared in the navel. By the time of hospitalization, its dimensions are 4x3 cm, the diameter of the umbilical ring is 2 cm. A planned operation was performed on 03.21.06. A hernial sac is highlighted. Aponeurosis is highlighted around the hernial portal for 3 cm from the peritoneum. A 5 x 6 cm polypropylene mesh was sewn into the center with two cruciform sutures and placed under the aponeurosis in the bed previously prepared in the preperitoneal tissue, so that the free ends of the cruciform sutures located in the center of the prosthesis were facing outward (towards the aponeurosis). With these ends of the cruciform sutures, the aponeurosis was sewn in 4 places mutually perpendicular to the aponeurosis at a distance of 1.5 cm from the edges of the hernia gate. A purse string suture was placed on the edges of the hernia gate and tied over a prosthesis. The corresponding ends of the cruciform sutures remaining above the aponeurosis were tied in pairs. The surgical wound was sutured in layers leaving polyvinyl chloride drainage in the subcutaneous tissue. The postoperative course is smooth. Discharged 6 days after surgery. She currently feels well and does not limit physical activity.

Example 2. Patient N., 54 years old, was operated on as planned for an irreparable umbilical hernia as described above. The hernial sac measuring 6 × 6 cm is set into the abdominal cavity. The hernia gate is 3 cm in diameter. The aponeurosis around the hernia gate is separated along the side adjacent to the peritoneum for 3 cm, and a 6 × 6 cm polypropylene mesh is placed in the formed bed, which is fixed to the aponeurosis with two cruciform sutures with the last one inserted 2 cm from the edge hernia gate. The hernia gate is sutured with a purse string suture, after which the ends of the threads of the cruciform sutures are tied.

The postoperative course is smooth. The patient was discharged for outpatient treatment on the 8th day after surgery.

Example 3. Patient G., 61 years old. Diagnosis: umbilical hernia. Operated as planned. The diameter of the umbilical ring is 1 cm. A polypropylene mesh 3 × 3 cm in size is fixed in the formed bed in the preperitoneal fiber around the hernia gate and is fixed to the aponeurosis with two cruciform sutures at a distance of 1 cm from the hernia gate. The hernia gate is sutured with a purse string suture, after which cruciform sutures previously imposed are tied.

The claimed method has the following advantages.

1. Technical ease of implementation.

2. Possibility of use even with very small sizes of hernial gates.

3. The risk of developing postoperative complications in the wound is reduced and the strength of the tissues involved in hernioplasty is increased, since aponeurosis skeletonation around the hernial gate from the subcutaneous tissue is not required.

4. The time of alloplasty is reduced, approaching the duration of the operation with plastic surgery by local tissues.

Claims (1)

A method of plasticizing hernias of the anterior abdominal wall with small sizes of the hernial collar, including an incision of the anterior abdominal wall above the hernial protrusion, isolation and reduction into the abdominal cavity of the hernial sac, separation of the aponeurosis 3-4 cm around the circumference of the hernial collar from the inside, placement of the prosthesis under the aponeurosis in the prepared a bed in preperitoneal tissue, characterized in that the placed prosthesis is stitched in the center with two cruciform sutures, both ends of which are stitched with an aponeurosis at a distance of 1-2 cm from the edges of the hernia exit gate and tie the specified seams over the hernia gates sewn up by a purse-string seam.