Options for the treatment of the femoral hernia with atrophy of the public bone in the formed femoral canal

Femoral hernias make up 2–4 % of the total number of patients with hernias [1], the results of their treatment do not tend to improve [2–6].The aim of the study was to establish the incidence of atrophy of the pubic periosteum in patients with femoral hernia and to analyze the possible methods of surgery in their treatment.Material and methods. The analysis of the treatment of 249 patients with femoral hernias for the period from 1996 to 2021 was carried out. There were 61 men (24.5%), women – 188 (75.5%). in 14 (5.6%), atrophy of the pubic periosteum was revealed during operations. Since 2009, patients with femoral hernia and atrophy of the pubic periosteum began to use the "Method for the treatment of inguinal and femoral hernias" (patent for invention No. 2445002, authors V.I. Belokonev, A.V. Vavilov, A.V. Zharov, Yu. V. Ponomareva, A.G. Nogoga) [11], which was performed by inguinal access.Conclusions. In 5.6% of patients with femoral hernia and a long history, under the influence of the hernial sac, atrophy of the pubic periosteum occurs.A method of treating femoral and inguinal hernias by closing the hernial orifice with an elastic mesh with a protrusion at the medial edge of the mesh corresponding to the distance from the medial edge of the pupar ligament at the level of the femoral vein to the lower edge of the superior horizontal branch of the pubic bone (patent for invention No. 2445002) is an effective method of treating patients with hernias with destruction of the pubic bone periosteum in the femoral canal.

A Study of Intraperitoneal Onlay Mesh Repair Using Barbed Sutures for Abdominal Incisional Hernia

Objective We investigated the validity of our intraperitoneal onlay mesh (IPOM) Plus technique with barbed sutures. Background Laparoscopic intraperitoneal onlay mesh repair has become a proven method for treating abdominal incisional hernias in recent years. There have been a few reports on the utility of IPOM Plus, which is IPOM + celiorrhaphy, although this method has not been widely discussed. We adopted the IPOM Plus technique with barbed sutures at our hospital and investigated the validity of this technique. Methods We included 7 patients who underwent IPOM Plus repair from 2015 to 2017 at our hospital. We excluded patients with a hernia hilum <2 cm or ≥10 cm, age < 20 years old, PS3 or more, and uncontrolled comorbidity. The hernial orifice was closed laparoscopically using barbed sutures and subsequently secured by tacking on an onlay mesh. Results The median hernial orifice size of the 7 patients was 45 mm (25 to 55 mm). Hernia onset occurred after laparotomy in all cases. In one case, an abdominal incisional hernia recurred after IPOM used to treat the condition 15 years earlier. The mean duration of surgery was 80.5 minutes (53 to 126 minutes), and the median pain scale score was 3 points (0 to 3 points), indicating little pain. None of the patients reported persistent postoperative pain. The mean duration of the postoperative hospital stay was a median of 3.5 days (2 to 5 days). Both short- and long-term outcomes indicated that no recurrence or complications, such as bulging or seroma, occurred. Conclusions IPOM Plus with intracavitary abdominal suturing using barbed suture for abdominal scar hernia repair may be a valid surgical procedure.

Method of prevention of postoperative gray allohernioplasty in laparoscopic ventral hernia

The authors have developed a new method of seroma formation prevention after laparoscopic allohernioplasty in patients with postoperative ventral hernias. The results of the study showed that trans- position of hernia sac into the abdominal cavity and fixation to the unmodified abdominal wall around the perimeter of the hernial orifice can reliably eliminate Grajewo cavity and thereby to eliminate the possibility of seroma formation in the postoperative period. Federal service for intellectual property (Rospatent) decided to grant a patent for this method of seroma formation prevention at the surgery of postoperative ventral hernias as for the invention “Method of laparoscopic plasty of ventral hernias” (№2017120227/14(035085) from 17.01.2018).

Laparoscopic Treatment of Retrocecal Hernia: Technical Notes and Literature Review

Retrocecal hernia is a rare cause of mechanical ileus and requires surgical treatment in emergency. Laparoscopy is not a frequent approach in this type of pathology. The diagnosis preoperative is not easy despite the TC can provide information to that effect. We present the case of a 52-year-old male patient with no comorbidity and never operated on the abdomen previously, which arrives in the emergency room with symptoms of acute abdomen. Practice direct Rx abdomen and TC abdomen that highlight an ileal stop without signs of decompensation. It is implemented, first instance, a conservative therapy, naso-jejunal tube and gastrographin intake by the way oral. Due to the persistence of occlusive symptoms, he underwent surgery after 24 hours. In laparoscopy we highlight a retrocecocolic hernia that strangles the last ileal loops. Proceed to section of the throttling track and to the opening of the entire laterocolic shower on the right with the resolution of the occlusive frame. Laparotomy has been avoided; laparoscopy made it possible to diagnose and guarantee a minimally invasive treatment with rapid recovery of the patient. We did not consider it appropriate to close the hernial orifice as described by several authors in the literature. The technique is described laparoscopy comparing it with other authors.