SU1598977A1 - Method of treating giant ventral hernia - Google Patents

Abstract

The invention relates to medicine, namely to surgery, and can be used in the treatment of giant hernias. The purpose of the invention is to increase the effectiveness of hernioplasty by reducing the tension of the wound edges and reducing the compression. After the release of the hernial bag, it is cut longitudinally, flaps are modeled. The flaps are doubled by everting and stitching their edges to the front wall of the sheaths of the rectus abdominis muscles, the resulting flaps are stitched together through the seams, capturing the sheaths of the rectus abdominis muscle, after which the upper flap is fixed to the front wall of the sheath of the rectus abdominis muscle. 4 il.

Description

The invention relates to medicine, in particular to the surgery of hernia of the abdomen, and can be used for giant hernias.

The purpose of the invention is to increase the effectiveness of herniogeschastics by reducing the tension of the wound edges and intra-abdominal pressure.

The method is carried out in the following manner.

After a preliminary 2-3 week compression workout of the abdomen under a combined endotracheal anesthesia, a wide longitudinal incision is made in the skin and hernial sac. A thorough revision is performed, the adhesions are dissected, the internal organs are released from the hernial sac, separated from the anterior abdominal wall. The pre-surgery plan for the plasty of a 1-defect defect is specified. The hernial sac is separated from the skin-subcutaneous flap over the entire length. The edges of the cicatricial-aponeurotic defect of the abdominal wall are separated in the course of 4 cm. Defects and weak (source) areas of the hernia sac flaps are sutured and supported. Kapron seams. The grafts of the hernial bag are plastically modeled for their subsequent quadrupling, notching, removing the excess tissue and aligning the edges (Fig. 1). The right and left patches of the hernial Mashka turn outwards and their edges are fixed cap-. Ron sutures to the inner contour of the vagina straight m, sh1ts shsh residues

 aponeurosis of the midline abdomen (Fig. 2), forming a duplicator.

On both of the doubled flap hernial sac pre-impose

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the flaps passing through the edge and the internal contour of the vagina of the rectus abdominis muscle (4ig, 3). The overlapped squamous suture threads are tightened simultaneously, which prevents their initial cutting. After approaching and adapting the doubled flaps, they did not weaken the tension of the threads, the latter tied in succession. The edge of the upper lobe of the hernial sac is rotted by the third row of stitches to the front wall of the vagina of the abdomen (Fig. 4). The defect of the abdominal wall is thus covered with a quadruple hernial bag, securely inked to the apo-neurotic structures.

For example. Patient G., 55 years old, was admitted to the hospital with a diagnosis of a giant postoperative ventral hernia. Three times after an appTdectomy there was eventration, secondary sutures were applied. Hernial vascularization occurred after 4 months. Upon admission, the patient is in a high-nutrition state. Hernial gland cm, partially penetrable into the abdominal cavity. In the right iliac region there is a labial fistula. Preoperative preparation for 2 months - compression training of the abdomen, exercise therapy, breathing exercises, diet, antihypertensive and cardiac drugs. During operations under endotracheal anesthesia and epidural anesthesia, a marked adhesion process was found in the hernial sac and abdominal cavity. Resection done

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80 cm of small intestine, hen fistula, with the imposition of the anastomosis. Taking into account that the defect of the abdominal wall is large and when the edges of the aponeurosis come closer, a buccal tension occurs, it was decided to use a hernia sac for plastics. Duplication of the right and left sheets of the hernial sac was performed, and then a dupipature was formed from them. Thus, the defect in the aponeurosis was securely closed by a quadruple hernial sac. After 1 month, the patient was discharged home in a satisfactory condition. Examined after 6 months and 1 year - the scar is soft, no compaction, relapse, absent.

Patients operated on in a pre-NbiM manner have good long-term results. The method is recommended for giant hernias accompanied by a large defect in the abdominal wall.

25 Form

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the invention

A method for treating giant ventral hernias, including plastics of the hernia gate with hernia sac elements, in order to increase the effectiveness of hernia repair by decreasing the tension of the wound edges and the intra-abdominal pressure, replacing the aponeurosis defect with the hernia sac, for this purpose cut through the hernial bag, after which its walls are folded in half and sewn between the - itself.

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Claims (1)

Claim A method for the treatment of giant ventral hernias, including hernia repair using elements of the hernial sac, characterized in that, in order to increase the effectiveness of hernioplasty by reducing the tension of the wound edges and intraperitoneal pressure, the aponeurosis is replaced by elements of the hernial sac, for this, the hernia is longitudinally dissected bag, after which its walls are folded in half and sewn together. Fig. / Fig. 2 5