scholarly journals Optimization of the choice of laparoscopic and open alloplastic surgery of postoperative ventral hernias

2020 ◽  
pp. 289-291
Author(s):  
Ya.P. Feleshtynskyi
Keyword(s):  
Wound Infection ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Rectus Abdominis ◽  
Postoperative Treatment ◽  
Abdominal Pressure ◽  
Electrolyte Balance ◽  
Preoperative Preparation ◽  
Diastasis Recti ◽  
Ventral Hernias

Background. Postoperative ventral hernias (PVH) account for 20.4-22 % of all abdominal hernias. The recurrence rate after alloplastic surgery of large and giant PVH is 10-25 %. Adequate selection of alloplastic surgery method in PVH may help to improve treatment outcomes and reduce the frequency of relapses. Objective. To describe the features of laparoscopic and open alloplastic surgery of PVH. Materials and methods. Analysis of literature sources on this topic. Results and discussion. According to the classification, PVH are divided into medial (subxiphoid, epigastric, umbilical, subumbilical, suprapubic) and lateral (subcostal, flank, iliac, lumbar). Autoplastic surgery (according to Sapezhko, Mayo) is used only for small-sized PVH in young and middle-aged people in the absence of diastasis recti and obesity (up to 3.5 %). In 96.5 % of cases alloplastic surgery is used (open – 81.1 %; laparoscopic – 15.4 %). There are about a dozen types of alloplastic interventions. When choosing the optimal intervention, it is necessary to take into account the width of the defect, the width of diastasis or contracture of the rectus abdominis muscles, the level of intra-abdominal pressure. When performing laparoscopic alloplastic intervention, prevention of trocar wound infection is performed using Dekasan solution (“Yuria-Pharm”) by rinsing before suturing. Alloplastic surgeries of giant PVH should be performed in combination with techniques for separating the anatomical components of the anterior abdominal wall and mandatory monitoring of intra-abdominal pressure, as intra-abdominal hypertension is a frequent complication of such procedures. Preoperative preparation and examination of patients before PVH surgery includes laboratory tests (general and biochemical blood tests, coagulation analysis), electro- and echocardiography, ultrasound or computed tomography of the required areas, spirography, consultations with related specialists, slag-free nutrition and 10-12 days of laxatives (in the outpatient settings), correction of comorbidities, maximum bowel cleansing before surgery, control of intra-abdominal pressure, prevention of infectious complications of the wound and prevention of thromboembolic complications. Contraindications to elective surgery include ineffective preoperative preparation, impaired cardiopulmonary activity, increased intra-abdominal pressure >12 mm H2O using bandage compression, reduction of breathing function <60 % of normal. To prevent postoperative wound infection during surgery at the stages of separation of the anatomical components of the anterior abdominal wall, fixation of the mesh and before drainage and suturing the wound, Decasan washing is used (400-800 ml depending on the wound surface area). Postoperative treatment includes analgesia (paracetamol – Infulgan, “Yuria-Pharm”), oxygen therapy, abdominal bandaging, monitoring of intra-abdominal pressure, stimulation of intestinal function (metoclopramide – Reosorbilact, “Yuria-Pharm”), antibacterial treatment, correction of electrolyte balance, nonsteroidal anti-inflammatory drugs. Removal of drainages from the mesh implant is performed in 3-4 days, from the subcutaneous wound – in 5-6 days. Conclusions. 1. The choice of PVH alloplastic surgery type should be made taking into account the size of the defects, the width of the diastasis recti and intra-abdominal pressure. 2. Optimization of the choice of treatment procedure for giant PVH can be achieved by determining the intra-abdominal pressure during surgery during contact of the rectus abdominis muscles. 3. Decasan lavage is used to prevent infection of trocar and surgical wounds.

scholarly journals Subcutaneous Onlay Laparoscopic Approach (SCOLA) for Umbilical Hernia with Diastasis of Rectus Abdominis Muscle: A Case Report

2021 ◽  
Author(s):  
Halil Afsin Tasdelen
Keyword(s):  
Umbilical Hernia ◽  
Video Clip ◽  
Laparoscopic Approach ◽  
Rectus Abdominis ◽  
High Recurrence Rate ◽  
Anatomical Landmarks ◽  
Rectus Abdominis Muscle ◽  
Hernia Defect ◽  
Diastasis Recti ◽  
Ventral Hernias

Abstract Diastasis of the rectus abdominis muscles (DRAM) is a common pathology, usually associated with midline abdominal wall hernias. The midline ventral hernias with diastasis have a significantly high recurrence rate, so repairing the hernia defect and the diastasis should be considered. Claus et al. previously described the subcutaneous onlay laparoscopic approach (SCOLA). We report a case of diastasis recti associated with umbilical hernia repaired with SCOLA technique. A 46-year-old male patient presented with a disturbing bulge in the upper midline and painful umbilical swelling. The CT scan followed by physical examination revealed 28 mm. umbilical hernia and 35 mm. diastasis recti. We aimed to introduce the SCOLA technique using a narrated video clip and showed all the critical steps and anatomical landmarks in the video. The postoperative period was uneventful, and the patient was discharged on the second postoperative day. The SCOLA technique is a feasible and reproducible alternative for the repair of midline hernias associated with DRAM.

scholarly journals Ventral hernia from routine repairs to abdominal wall reconstruction: our initial experience

2020 ◽  
Vol 7 (10) ◽  
pp. 3348
Author(s):  
Sheetal Ishwarappagol ◽  
Rohit Krishnappa
Keyword(s):  
Abdominal Wall ◽  
Ventral Hernia ◽  
Abdominal Wall Reconstruction ◽  
Tobacco Consumption ◽  
Transversus Abdominis ◽  
Abdominal Pressure ◽  
Postural Stabilization ◽  
History Of ◽  
And Function ◽  
Ventral Hernias

Background: Loss of continuity of abdominal wall significantly affects the functions of protection of viscera, postural stabilization, and maintenance of intra-abdominal pressure. The newer understanding of abdominal wall reconstruction (AWR) aims at restoring abdominal wall anatomy and function, instead of simply patching the defect. We want to showcase the changing trends and results in hernia repair at a Medical Institution.Methods: This is an observational retrospective study conducted in RRMCH, Bengaluru from July 2018-2019 including all patients with ventral hernia undergoing the specified hernia repairs.Results: A total of 54 patients with ventral hernias undergoing routine hernia repairs/AWR surgeries were retrospectively analysed. The overall mean age was 46.62±12.44 year. Majority subjects were females (n=37; 68.5%), and overweight (Mean BMI=28.07±3.01/m2). 14 patients (25.92%), all males, had history of tobacco consumption. There were 38 (70.37%) primary ventral hernias and 7 recurrent hernias. Overall mean defect size was 10.2±0.4 cm. Most frequently performed was open retro rectus Hernioplasty (n=18; 33.33%), followed by open Preperitoneal Hernioplasty (n=17; 31.48%), laparoscopic intraperitoneal onlay mesh (IPOM) (n=16; 29.62%) and open transversus abdominis release (TAR) (n=3; 5.5%). On statistical analysis, it was found that Open repairs had higher post-operative pain (p=0.0005), longer hospitalization (p=0.0002) and higher incidence of surgical site events (p=0.0134) when compared to Laparoscopic repairs.Conclusion: As known already, minimally invasive techniques of hernia surgeries are shown to have acceptable outcomes when compared to radical open surgeries. Newer techniques of AWR are being employed to routine cases in larger numbers, and not just for complex reconstruction, at most centres with acceptable outcomes. 

scholarly journals Reconstruction of the anterior abdominal wall with postoperative ventral hernias by a modeled implant

2019 ◽  
Vol 1145 ◽  
pp. 012010
Author(s):  
I Kalyakanova ◽  
A Protasov ◽  
Z Kaitova ◽  
A Kulakova ◽  
A Kodirova ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Ventral Hernias

scholarly journals A case report of aponeurotic origin of rectus abdominis

2014 ◽  
Vol 03 (02) ◽  
pp. 84-86
Author(s):  
Challa Ratna Prabha ◽  
Namburu Bhanu Sudha Parimala
Keyword(s):  
Case Report ◽  
Abdominal Wall ◽  
Andhra Pradesh ◽  
Anterior Abdominal Wall ◽  
Pubic Symphysis ◽  
Rectus Abdominis ◽  
General Surgeon ◽  
Pubic Tubercle ◽  
Middle Aged ◽  
Medical College

AbstractRectus abdominis is a long strap like muscle that extends along the entire length of anterior abdominal wall. Normally the rectus abdominis arises by two tendons. The larger lateral tendon attached to the crest of the pubis, pubic tubercle up to pectineal line. The medial tendon is attached to the pubic symphysis. The fleshy fibers of rectus abdominis replaced by aponeurosis below the umbilicus was found during the routine dissections of a middle aged female cadaver at Dr. Pinnamaneni Siddhartha Medical College, Chinnavutapalli, Andhra Pradesh, India. The knowledge of partial or complete absence of rectus abdominis and other anterior abdominal wall musculature is of immense importance for the General surgeon, Anatomist and the Gastroenterologist.

scholarly journals Peculiarities of surgical tactics in postoperative ventral hernias in elderly patients

2011 ◽  
Vol 4 (1) ◽  
pp. 10-16
Author(s):  
Maksim Aleksandrovich Evseev ◽  
Roman Anatolievich Golovin ◽  
Dmitry Nikolaevich Sotnikov ◽  
Nataliya Mikhailovna Lazarieva
Keyword(s):  
Postoperative Complications ◽  
Elderly Patients ◽  
Abdominal Wall ◽  
Age Groups ◽  
Selection Method ◽  
Preoperative Preparation ◽  
Preparation Program ◽  
Algorithmic Approach ◽  
Surgical Tactics ◽  
Ventral Hernias

The questions of surgical tactics in large and giant postoperative hernia in patients of older age groups. An analysis of the causes of recurrent hernias and postoperative complications identified the need to use algorithmic approach to the selection method of plasty of abdominal wall, defined the criteria for the possibility of operational benefits in patients with severe concomitant diseases, as well as a preoperative preparation program.

scholarly journals On the features of the preperitoneal space multifascial structure in clinical and anatomical issues

2021 ◽  
Vol 40 (1) ◽  
pp. 65-70
Author(s):  
Yuliуa A. Boytsova ◽  
Nikolay F. Fomin ◽  
Viktor V. Shvedyuk
Keyword(s):  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Meta Analysis ◽  
Infectious Complications ◽  
Preperitoneal Space ◽  
Control Groups ◽  
Safe Method ◽  
Hernia Formation ◽  
And Control ◽  
Ventral Hernias

AIM: to determine the prospects for the preventive endoprosthetics of the abdominal wall at preventing the development of postoperative ventral hernias. MATERIALS AND METHODS: A meta-analysis of the literature data performed to determine the effectiveness of preventive endoprosthetics for the prevention of ventral hernia formation. Topographical study has been conducted to explore the most promising levels of the mesh location. RESULTS: During the meta-analysis it has been found that performing preventive endoprosthesis of the anterior abdominal wall t in the preperitoneal space reduces the frequency of ventral hernias. There were no significant differences in the frequency of infectious complications and serom in the experimental and control groups according to studied publications. During the preparation it has been distinguished that between the transverse fascia and the peritoneum there is a preperitoneal fascia consisting of two leaves, which is most manifest in the lateral parts. In the umbilical region above linea arcuata the preperitoneal fascia is thinned and represented by separate fibers that are difficult to differentiate as a structure between the transverse fascia and the peritoneum. In the lateral parts of the abdominal wall, the preperitoneal fascia is well expressed. It has been distinguished that the retroperitoneal fascia, formed by the junction of two sheets of the Gerot fascia continues into the fascia between the transverse fascia and the peritoneum. CONCLUSION: Preventive endoprosthesis of the anterior abdominal wall is an effective and safe method of preventing the formation of postoperative ventral hernias. The anterior abdominal wall is characterized by a complex multifascial structure, which is of fundamental importance for various types of surgery. Between the transverse fascia and the peritoneum there is preperitoneal fascia which is represented by two leaflets. Its continuation is the retroperitoneal fascia (5 figures, 2 tables, bibliography: 8 refs).

scholarly journals Abdominal Wall Endoscopic Extraperitoneal Reconstruction Technique in Patients with Primary Midline Hernias and Diastasis of the Rectus Abdominis Muscles

2021 ◽  
Vol 14 (1) ◽  
pp. 19-24
Author(s):  
Vladislav Sergeevich Rakintsev ◽  
Anatolii Vladimirovich Yurasov
Keyword(s):  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Rectus Abdominis ◽  
Reconstruction Technique ◽  
Type I ◽  
Anatomical Landmarks ◽  
Confined Space ◽  
Needle Holder ◽  
White Line ◽  
Surgical Department

Introduction. The paper focuses on technical features of endoscopic extraperitoneal reconstruction (EER) of the anterior abdominal wall in patients with primary median hernias combined with diastasis of the rectus abdominis muscles, the nuances of the operating room equipment and preparation of patients for intervention.The aim of the study was to analyze the stages and features of the technique for performing endoscopic extraperitoneal reconstruction of the anterior abdominal wall to ensure safe and qualified implementation of the operation in clinical practice.Materials and methods. This research was a prospective study including 45 clinical cases of patients with primary median hernias of the anterior abdominal wall combined with diastasis of the rectus abdominis muscles, who were exposed to endoscopic extraperitoneal reconstruction. The study was performed in the surgical department of the private healthcare facility "Central Clinical Hospital Russian Railways-Medicine" in 2019-2020. The median follow-up was 14 months (8 - 18 months), there were no complications estimated higher than type I according to the Clavien-Dindo classification and relapses.Results and discussion. Successful EER requires thorough preoperative preparation: to connect a second monitor; to distance anesthetic equipment; to ensure the patient is in an extension position in the lumbar segment of the spinal column; to identify principle anatomical landmarks under ultrasound control. The main two stages of EER - mobilization and reconstruction - are performed extraperitoneally in a confined space, and therefore the localization of the ports must be anatomically validated. The major point at the stage of mobilization is to maintain the integrity of the parietal peritoneum, this solves visualization problems and helps to work in the required layer of the anterior abdominal wall. Adherence to the principles of open surgery, namely, orientation of the needle holder at an angle close to 0 to the suture line (white line), and the needles at a right angle; maintaining working angles between the instruments 30-60, - allows effectively performing the reconstructive stage.Conclusion. Thus, a topographic-anatomically based approach to each stage of the operation and adherence to a set of features of the surgical technique allows safely and effectively applying EER for the treatment of patients with primary midline hernias and diastasis of the rectus abdominis muscles.

scholarly journals Rives – Stoppa surgery – the foundation of the modern concept of treatment of patients with ventral hernias (55 years in surgery)

2021 ◽  
Vol 179 (6) ◽  
pp. 107-110
Author(s):  
V. V. Semenov ◽  
A. A. Kurygin ◽  
S. D. Tarbaev ◽  
A. A. Mamoshin
Keyword(s):  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Rapid Development ◽  
Polymer Materials ◽  
Long Term Results ◽  
Modern Concept ◽  
Urgent Problem ◽  
Results Of Treatment ◽  
History Of ◽  
Ventral Hernias

The treatment of ventral hernias in the history of surgery has always been an urgent problem. In the 90s of the XIX century, hernioplasty using metal threads and plates began, but the long-term results of treatment of patients remained unsatisfactory. A particularly urgent problem in herniology during the last century was the treatment of postoperative ventral hernias, and patients with large and even more giant hernias were often recognized as incurable. The great revolution in herniology was the introduction into practice of biologically inert mesh polymer materials. A fundamentally different method of endoprosthesis of the abdominal wall is retromuscular («sublay») hernioplasty, proposed by the French surgeon of Algerian origin Rene Stoppa in 1965. In 1966, a compatriot, colleague and friend R. Stoppa Jean Rives used the principles of this technique when eliminating postoperative median hernia by prosthetics of the anterior abdominal wall retromuscularly through the xiphopubic incision. Decades later, during the rapid development of endovideosurgery, the principle of operation Rives-Stoppa was the foundation for the development of modern minimally invasive and highly effective methods for eliminating inguinal and other ventral hernias. Thus, the method of prosthetics of the anterior abdominal wall proposed 55 years ago by Rives-Stoppa was an ideological breakthrough in herniology and significantly improved the results of operations for external abdominal hernias.

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