CHOOSING THE METHOD OF PORT-SITE HERNIAS REPAIR COMBINED WITH THE DIASTASIS OF THE STRAIGHT MUSCLES OF THE ABDOMEN
About the author:
Feleshtynsky Ia. P., Dadayan V. А.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
The analysis of surgical treatment of 85 patients with paraumbilical port-site hernias, combined with a diastase of rectus muscles of width from 3 cm to 10 cm was carried out. Women were 52 (61.2%), men 33 (38.8%). Port-site hernias in all patients were observed after laparoscopic cholecystectomy. In all patients, a combination of a hernia defect with diastase of direct abdominal muscles in the width from 3 cm to 10 cm was observed. In 15 patients with small size of the port-site hernia and 28 with average size, the width of direct muscle diastase was determined to 3 cm, and in 42 patients with large size of the port-site hernia, diastase of the direct muscles was observed more than 3 cm and reached 10 cm. Depending on the method of allogernioplasty with the elimination of diastase of the rectus muscles or without its elimination, the patients were divided into 2 groups. The first (main) group consisted of 43 patients who underwent laparoscopic allogernioplasty using the intra-abdominal mesh “Parietex composite” and the elimination of diastase of the rectus muscles by transfascial sutures. Patent for the utility model, and open alloplasty “sublay” using a polypropylene mesh and the elimination of diastase of the rectus muscles. It is precisely this approach to the choice and implementation of laparoscopic or open-ended allergic optics depending on the width of the diastase of the rectus abdominal muscles based on the technical possibilities of closing the hernia defect and eliminating the diastase of the direct muscles without significant tension of the tissues. Elimination of diastase in patients of the main group was mandatory. The second group (comparisons) consisted of 42 patients who underwent laparoscopic allogernioplasty using the intra-abdominal mesh “Parietex composite” without the elimination of diastase of the rectus muscles and an open procedure with the preperitoneal placement of the mesh polypropylene implant, the muscle-aponeurotic edges of the defect were stitched contact over the mesh. Above and below the strengthened defect, the straight muscles were not sutured. An open technique with preperitoneal placement of a mesh polypropylene implant was performed in 20 patients with large port-site hernias. The muscular-aponeurotic edges of the defect were stitched over the net. Above and below the fortified defect, straight muscles were not sewn. Allogernioplasty of port-site hernia combined with diastase of the rectus abdominis muscles, both laparoscopic and open without the elimination of diastasis of the rectus muscles is accompanied by relapses.
diastasis direct muscle, atrophy of muscle-aponevrotych tissue, port-site hernias, laparoscopic cholecystectomy, prevention of port-site hernias
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 3 (145), 2018 year, 187-190 pages, index UDK 616.381-072.1-089.168.1-06:617.55-007.43-06:[611.736-007.483:617.55-089.844]