RU2735928C1 - Method for uncomplicated small umbilical hernia repair - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery, herniology. Hernial sac is accessed through the navel through a cross-section incision not extending beyond the umbilicus, as a result of which four identical skin flaps are produced with uniform excision of excess skin on each side of the flap. Then the hernia sac is separated and inserted into the abdominal cavity or excised beyond the zone of the cicatrical tissue attached to the umbilical ring along the circumference. Umbilical ring is closed in a zone of a white abdominal line, starting from the right and below from the navel ring, performing the first prick inside from outside. Then, on the same side to the right of umbilical ring, but in upper sections is sutured from the outside to inside. Then, diagonal is moved to opposite edge and is sutured from inside to outside, finishing plastic stage by stitch also on the left and above from umbilical ring from the outside to inside, that finally the first and last stitches are on opposite sides along diagonal. After the plastic stage, the sutures are not cut off, and the umbilicus is formed from the above skin flaps by means of an intracutaneous continuous suture. Skin is stitched in the area of skin grafting angles to their middle, and at the end of the operation the knots that are submerged are knotted.

EFFECT: method improves reliability of hernioplasty results in uncomplicated small umbilical hernias, allows forming a full aesthetic navel.

1 cl, 1 ex

Description

The invention relates to medicine, namely to surgery and can be used for plastics of uncomplicated small umbilical hernias.

External abdominal hernias occur in 3-4% of the population. Potential hernia carriers are 20-33% of the world's inhabitants. The umbilical ring is one of the "weak" areas of the anterior abdominal wall. (Alibegov R.A. Trans-umbilical access in the treatment of umbilical hernias / R.A. Alibegov, S. S. Melkonyan // Bulletin of new medical technologies: electronic journal. - 2013. - No. 1. - 125 p.; Egiev V.N. Tension-free hernioplasty / VN Egiev. - M: Practice, 2002. - 148 p.; Zhebrovsky VV Surgery of abdominal hernias / VV Zhebrovsky. M .: MIA, 2005. - 400 p.).

According to the frequency of occurrence, the share of umbilical hernias, according to the literature, accounts for 11.7% of all operated external hernias, advancing them to the second place after inguinal hernias (Alibegov R.A. Crespiral access in the treatment of umbilical hernias / R.A. Alibegov, S. S. Melkonyan // Bulletin of new medical technologies: electronic journal. - 2013. - No. 1. - 125 p .; Egiev V.N.Atlas of operative hernia surgery / V.N.Egiev, K.V. Lyadov, P. K. Voskresensky. - M .: Medpraktika, 2003. - 228 p.). The opinion that the treatment of umbilical hernias is a resolved issue is erroneous. Speaking of umbilical hernias, two of the varieties should be distinguished: small hernias and large hernias. According to the conducted research, any methods of treating small umbilical hernias give good results. However, the assessment of the latter is mainly concerned with the reliability of the results and the reduction in the frequency of relapses. Nevertheless, cosmetic considerations, the technical simplicity of the surgical intervention should also play an important role in the choice of access to the hernial sac and the method of repair of the hernial defect. Therefore, further search for more reliable, at the same time, technically simple and satisfying cosmetic requirements is relevant.

There are various methods of hernioplasty for umbilical hernias with local tissues. Among them is the method of plastic surgery according to Lekser (Egiev V.N. Atlas of operative hernia surgery / V.N.Egiev, K.V. Lyadov, P.K. Voskresensky. - M .: Medpraktika, 2003. - S. 144-145) ... The operation starts with a transverse skin incision immediately below the navel. The skin and subcutaneous tissue are dissected to the aponeurosis. The hernial sac is isolated and inserted into the abdominal cavity or excised. On the perimeter of the hernial opening, the aponeurosis and the anterior sheets of the sheaths of the rectus abdominis muscles are isolated by 3-4 cm. Next, a purse-string suture is applied around the hernia orifice with polypropylene thread No. 0. The purse-string seam is tightened and tied. Then an additional 3-4 single sutures are applied over it, bringing together the edges of the sheaths of the rectus abdominis muscles. The method is simple to implement. However, in adults it gives a large number of relapses and is used very rarely. The thing is that under the influence of intra-abdominal pressure, the threads erupt over time. In Mayo plastic surgery, after the neck of the hernial sac is isolated, the aponeurosis is dissected in the transverse direction, separated from the peritoneum while maintaining its integrity. The hernial sac is immersed in the abdominal cavity. The lower edge of the aponeurosis is sutured under the upper one to form a duplicate. After the imposition of the first row of sutures, the upper part of the aponeurosis is sutured to the lower (Egiev V.N.Atlas of operative hernia surgery / V.N.Egiev, K.V. Lyadov, P.K. Voskresensky. - M .: Medpraktika, 2003. - S . 147-155). The technique is simple, but its disadvantage is that the white line of the abdomen does not narrow, but rather expands. In addition, the separation of the aponeurosis from the subcutaneous tissue to create duplication can lead to seromas. A similar disadvantage is possessed by the Sapezhko technique, in which a duplicate of the aponeurosis is created, but in the longitudinal direction (Toskin KD Abdominal hernias / KD Toskin, VV Zhebrovsky. - M .: "Medicine", 1983 - S. 168-170).

The known method of tension-free plasty for umbilical hernia. It consists in the imposition and fixation of a mesh alloprosthesis over the hernial defect. In this case, after the isolation and reduction of the hernial sac, a mesh is cut out, in size exceeding the hernial gate by 2-3 cm on each side. It is fixed with sutures outward from the hernial orifice along the perimeter (Egiev V.N.Atlas of operative hernia surgery / V.N.Egiev, K.V. Lyadov, P.K. Voskresensky. - M .: Medpraktika, 2003. - 147 p. ). The advantage of the method is its higher reliability compared to plastics with local tissues. However, being located in the subcutaneous tissue, the implant can contribute to the formation of seromas and long-term non-healing fistulas. (Zhebrovsky VV Surgery of abdominal hernias and eventrations / VV Zhebrovsky, Mohammed Tom Elbashir. "Business-Inform", Simferopol, 2002, - pp. 176-177).

The technical result of the proposed method is to increase the reliability of the results of hernioplasty in uncomplicated small umbilical hernias and the formation of a full-fledged umbilical in terms of aesthetics by involving the surrounding local tissues, including skin flaps of the newly formed umbilical funnel, in the elimination of the expanded umbilical ring.

The proposed method is carried out as follows: access to the hernial sac is carried out through the navel through a cruciform incision that does not go beyond the navel, as a result, we get four identical skin flaps. After that, the excess skin is evenly excised from each side of the flap. This allows you to get more convenient access to the hernial sac, and then to the hernial orifices themselves, in addition to form dense, especially in the area of their bases, skin flaps for the formation of a new navel later. Next, the hernial sac is isolated and inserted into the abdominal cavity or excised. In this case, one should not go beyond the area attached to the umbilical ring around the circumference of the scar tissue. After that, suturing of the umbilical ring begins with a non-absorbable monofilament suture with an atraumatic needle. To achieve the desired result in the area of the white line of the abdomen near the umbilical ring, injections and punctures are sequentially performed, stitching the edges of the hernial defect. Sewing begins to the right and below from the umbilical ring, performing the first injection from the inside-out, then along the same side (to the right of the umbilical ring, but in the upper sections, stitching is done from the outside to the inside. After that, they move diagonally to the opposite edge, stitching it from the inside- outwards and end the plastic stage with a stitch also to the left and above the umbilical ring from outside to inside.In the end, the first and last stitches are on opposite sides diagonally, which allows when tying a knot to exert the most uniform load on the approaching sides of the hernial defect, to form a knot in the center After the plastic stage, the remainder of the thread is not cut off, but the navel is formed from the above-described skin flaps by means of an intradermal continuous suture. The skin is sutured in the area of the corners of the skin flaps approximately to their middle. At the end of the operation, knots are also tied. submersible character.

Thus, as a result of the preservation of the scar tissue attached around the circumference of the umbilical ring, the skin flaps are more tightly fixed to the sutured defect of the aponeurosis in the area of their bases. Due to the imposition of an intradermal suture in the area of their middle, skin flaps with their inner parts are fixed in the area of the eliminated umbilical ring, further strengthening it. This eliminates the contact of the contacting surfaces with the nodes, and also eliminates the space between the connected tissues. This promotes faster formation of scar tissue and increases the reliability of the plasty.

According to the technique developed by us, 42 operations were performed for uncomplicated small umbilical hernias. At the same time, the diameter of the hernial defects was up to 1.5 cm. In all cases, the operations were performed without complications. The observation period is up to 2.5 years. There were no recurrences of hernias.

Clinical example

The examined N., 56 years old, was admitted to the surgical department with a diagnosis of umbilical hernia. The operation was performed for hernia repair, plasty of the aponeurosis defect with local tissues. The hernial sac was accessed through the umbilicus by means of a cruciform incision within the umbilicus, resulting in four identical skin flaps. After that, we evenly excised the excess skin on each side of the flap. This allowed us to gain more convenient access to the hernial sac, and then to the hernial orifices themselves, in addition to form dense, especially in the area of their bases, skin grafts for the formation of a new navel later. Next, we selected the hernial sac. The latter was not opened and was inserted into the abdominal cavity. At the same time, we did not go beyond the area of the scar tissue attached to the umbilical ring along the circumference. After that, we began suturing the umbilical ring with a non-absorbable monofilament suture with a non-traumatic needle. To achieve the desired result in the area of the white line of the abdomen near the umbilical ring, the aponeurosis defect was sequentially sutured with a non-absorbable monofilament thread with an atraumatic needle. Then, using the same thread, a continuous suture was applied to the skin. There were no postoperative complications. No long-term complications or relapses were observed during observation for 2.5 years. A full-fledged navel was formed in the area of surgical intervention.

Claims (1)

The method of plastics of uncomplicated small umbilical hernias, characterized in that the access to the hernial sac is carried out through the umbilicus through a cruciform incision that does not go beyond the navel, as a result of which four identical skin flaps are obtained with uniform excision of excess skin on each side of the flap, then the hernial sac is isolated and set into the abdominal cavity or excised, without going beyond the area attached to the umbilical ring around the circumference of the scar tissue, then the umbilical ring is sutured in the area of the white line of the abdomen, starting from the right and below the umbilical ring, performing the first injection from the inside out, then along this the same side to the right of the umbilical ring, but at the same time in the upper sections they are stitched from the outside to the inside, then they move diagonally to the opposite edge and stitch it from the inside-out, completing the plastic stage with a stitch also to the left and above from the umbilical ring from the outside to the inside, which in the final as a result, the first and last stitches are on opposite sides along diagonally, after the plastic stage, the remains of the thread are not cut, but the navel is formed from the above-described skin flaps by means of an intradermal continuous suture, the skin is stitched in the area of the corners of the skin flaps to their middle, and at the end of the operation knots are also tied, which are submerged in nature.