SU1437005A1 - Method of treatment of postoperational iliac ventral hernia - Google Patents

Abstract

The invention relates to the field of medicine, namely to clinical surgery, and can be applied in the treatment of large iliac postoperative hernia, combined with severe forms of obesity. The purpose of the invention is to improve the conditions of adaptation and accretion of duplicate tissue, prevent the formation of adhesions in the abdominal region along the seams, increase the cosmetic effect of the treatment. To do this, the cuts, the shape and size of the removed skin and subcutaneous flap are planned, the lower lateral incision is made above and parallel to the lower abdominal crease from the mid axillary line to the midline of the abdomen, along the length of the defect, the edges of the abdominal wall are placed on the aponeurosis The weaker sutures are stitched, to the upper-medial flap, the nickel-lateral flap is hemmed with sutures that do not penetrate into its peritoneal layer, the peritoneum and the preperitoneal fatty tissue duplicating the upper-medial section are excised. go muscular aponeurotic flap. (L

Description

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The invention relates to medicine, namely to clinical surgery, and can be applied in the treatment of large ileal naso-operative hernias.

The purpose of the invention is to improve the conditions for the adaptation and accretion of tissues in case of large ventricular hernias, an increase in the cosmetic effect of the treatment, which is achieved by planning cuts, the shape and size of the skin-subcutaneous flap to be removed.

FIG. Figure 1 shows landmarks and lines along which the dimensions and shape of skin incisions and of the skin and subcutaneous flap to be removed are planned; in fig. 2 - overlapping screw seams; in fig. 3 and 4 are the stages of the creation of dualiculture.

The method is carried out in the following manner.

The hernial budding 1 is raised upwards and along the ei o of the lower-lateral surface recedes upward by 3 cm and parallel to the lower fold of the abdomen 2 from the mid axillary line 3 to the midline of the abdomen 4, the dye is applied to the skin with an open concavity along the underside of the lower tearasteral incision 5. In the healthy half of the abdomen, according to the notional line (, connecting the umbilicus 7 and the anterior superior bone 8 of the wing of the ilium, with a centimeter tape measure the distance Y from the navel 7 to the lower fold of the abdomen 2. Also measure the distance 10 between the same By the lines along the conditional line, connecting the navel 7 and the middle of the pupartite ligament. the points doped on the skin with the dye. Through the points between the ends of the line of the lateral incision 5 with the dye onto the skin of the papa of the line of the upper medial incision.

But the intended color line p) of the lateral tissue incision of the skin and subcutaneous fat before aponeurosis. Clips Mikulich seizure1.1 edge of the flap to be removed, nat | Ivai1 down from the top to the outside, and a vertical incision of the skin and subcutaneous fat is made at the same time before aponeurosis. The lower telescope1 and the upper media of the flap of the flap are brought into contact with each other and are gripped by the Miku clamps throughout. cha Under the flap upward, its subcutaneous fat layer is separated from the an () | Heb.) To the edges of the defect in the anterior abdominal wall and 1 of the hernial sac. In the area free from herniated hernia, the hernial MeinoK wrr1 1wyug. As the adhesions are separated, the window in the hernial membrane is enlarged, separated from its bee

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The fixed intestinal loops, fixed by the epiploon, resected, 2 cm from the hernia gate, cut off the hernial sac with a circular incision and, together with the subcutaneous cuticle and resected epiploon, are removed in a single block. Between the loops of the muscularis at the hernial ring and in the abdominal cavity, the adhesions are disconnected and the hernial contents are retracted into the abdominal cavity. The edge of the peritoneal-muscular-aponeurotic defect of the glandular wall along the length of the latter is dissected upwards and outwards to the wing of the Ilium, from the bottom to the tip to the outer edge of the abdomen. In u.g / suv of the defect of the bryupsh wall, on the aponeurosis three or four screw-ons are applied on the aponeurosis.

The lateral flap is stitched with lavsan through the muscular aponeurotic layer, without piercing its peritoneal layer. Then, by 3–4 cm from the edge of the edge, with the same threads, the upper medial bipedo-musculo-aponeurotic is stitched through all layers from the side of the abdomen. suede 24. Alternately, to the left, then to the right of the defect, from the periphery to its center, the seams are tied up to the perfect adaptation of the flaps. The upper edge of the upper medial flap 24 is podpodn up to the sutures, its brupepu 25 and the preperitoneal fat layer 26 are cut to the transverse fascia 27. The free edge of the upper medial flap 24 is spread out like a fan, moderately stretched and pulled to the apical seam of the lower material flap 20. washed with an antiseptic solution, drained over the entire course with two counter perforated PVC tubes and sutured in layers.

Example. Gzolnoy K., 48 years old, was admitted to the hospital with a diagnosis: the right-sided iliac postoperative ventral hernia is huge, 111 degrees obesity. After preoperative preparation is operated on. Under endotracheal anesthesia, bordering the hernial protrusion on both sides, an oblique semilunar incision about 35 cm long, planned in the preliminal way, from the middle perimeter lipnia to the midline of the abdomen in the right area, cut the skin-floor. together with a hernial bag and resected scar-modified omentum. Adhesions are separated at the edges of the hernial ring and in the cavity. The loops of the small intestine and the omentum cult are inserted into the palpable cavity. IN COSOPRO. 10L OM

the direction is dissected by the edges of the peritoneal-muscular-aponsvrotic defect down to the outer edge of the rectus muscle, upwards to the anterior axillary muscle. At the corners of the defect on the aponeurosis are screwed lavsan seams. We have an aponeurotic defect of the abdominal wall sutured with the creation of muscular aponeurotic duplication. The wound is washed with chlorhexidine solution, drained with two opposing holes with PVC tubes and sutured in layers. Squeezed rubber pears are connected to the outer ends of the tubes. Aseptic sticker is applied to the wound. The course of the early postoperative period is smooth. On the eleventh day after the operation, the stitches are removed. The wound healed by primary tension. Examined two years after surgery. Complaints do not show. Hernia recurrence is not. The belly is symmetrical. The scar is delicate, the excess skin folds in the scar area are undetectable. He considers himself healthy.

Thus, the proposed method of treatment of iliac postoperative ventral hernias is technically simple, does not require significant reconstruction of the abdominal wall, is distinguished by high therapeutic and cosmetic efficacy for large iliac ventral hernias, is recommended for practical use.

Claims (1)

Invention Formula A method of treating postoperative ileal ventral hernias, which includes excision of the skin graft by bordering incisions, hernia repair, and plasty of the anterior abdominal wall with local tissues to form a duplicate, characterized in that, with a whole improvement in the cosmetic effect of the operation, it is cut through the outer side of the hernia after a hernia. over the lower fold of the abdomen and parallel to it from the mid axillary to the midline, then project the lines connecting the navel to the front upper and the middle of the inguinal ligament, and mark them on the inner surface of the hernial bulge point at distances from the navel equal to those on the healthy side minus the fold of the abdomen and the incision on the outer side of the hernial bulge and then connect the ends of the latter with a cut through the marked points along the inside of the hernial protrusion. e. to h t / g R Fie.2 ae.5 iO / L Phie W