Shilenok V.N.*, Zeldin E.Y.*, Getsadze G.N.*, Podolinsky S.G.**, Zemko V.Y.*
Variants of postoperative and recidivating ventral hernias treatment
*Educational Establishment «Vitebsk State Order of Peoples’ Friendship Medical University», Vitebsk, Republic of Belarus
**Public Health Establishment «Vitebsk Town Clinical Hospital of Emergency Medical Aid», Vitebsk, Republic of Belarus
Vestnik VGMU. 2015;14(6):64-69.
Objectives. The number of people suffering from hernias doesn’t decrease recently, and the number of patients with postoperative hernias increases. 15020 herniotomies were perfomed during 5 years in Vitebsk region. The number of recurrences after operations for inguinal hernias reaches 8-10%. Reoperations for recurrent hernias, especially after Postempski operation, are very complicated.
Material and methods. The method of surgical treatment of relapsing inguinal hernias, that occur after Postempski operation, has been developed and introduced in the clinical hospital. The proposed method of unstretching hernioplasty is a modification of Lichtenstein technique, but there is no isolation of the spermatic cord all the way along during this operation. A positive result was received in 11 patients. There were no recurrences of hernias.
166 patients had postoperative ventral hernias (R0), 10 – had recurrences of postoperative hernias (R1). Alloplastic methods with the use of polypropylene mesh were used in 67 patients. Alloplasty was performed in case of diastasis of the edges of hernial orifice from 8 to 9 cm W2–W (SWR classification 1999).
Results. Plasty above aponeurosis «on lay» was performed in 61 patients, plasty by Napalkov-Troppoli with polypropylene mesh in V. I. Belokonev’s modification was perfomed in 6 patients. We aspirate seromas by using puncture in the postoperative period, if ultrasound examination shows that the thickness of the layer of liquid above the mesh is more than 1,5 cm. Punctate must be analyzed cytologically, because that allows to determine the presence of inflammation in the wound timely.
Conclusions. The application of the nontension alloplastic methods in practice enabled considerable improvement of the surgical treatment results. After alloplasty the relapse occurred in 2 cases (2,9%)
Key words: recurrent and postoperative hernias, alloplasty of hernial orifice.
1. Khirurgiia zhivota. Briushnyia gryzhi [Hirurgiya stomach. Abdominal hernias]. V: Tikhov" PI. Chastnaia khirurgiia. V 3 t. T 3. Khirurgіia zhivota. Khirurgіia verkhnikh" i nizhnikh" konechnostei. Petrograd, RF;1917. Р. 4-147.
2. Toskin KD, Zhebrovskiy VV. Gryzhi briushnoi stenki [Hernias of an abdominal wall]. Moscow, RF: Meditsina; 1990. 272 р.
3. Timoshin AD, Yurasov AV, Shestakov AL. Khirurgicheskoe lechenie pakhovykh i posleoperatsionnykh gryzh perednei briushnoi stenki [Surgical treatment of inguinal and postoperative hernias of a forward abdominal wall]. Moscow, RF: Triada-Kh; 2003. 144 р.
4. Zhebrovskiy VV. Khirurgiia gryzh zhivota [Surgery of hernias of a stomach]. Moscow, RF: MIA; 2005. 384 р.
5. Shilenok VN, Zeldin EYa, Kovaleva LA, Getsadze GN. Variant operatsii Likhtenshteina pri retsidivnykh i reretsidivnykh pakhovykh gryzhakh [Option of operation of Liechtenstein at recurrent and the reretsidivnykh inguinal hernias]. V: IX konferentsiia «Aktual'nye voprosy gerniologii», Moskva, 31 okt – 1 noiab 2012 g: materialy konf. Moscow, RF; 2012. Р. 229-30.
6. Egiev VN, Lyadov KV, Voskresenskiy PK, Rudakova MN, Chizhov DV, Shurygin SN. Atlas operativnoi khirurgii gryzh [Atlas of operational surgery of hernias]. Moscow, RF: Medpraktika; 2003. 228 р.