COMBINED METHOD FOR APPLYING DIFFERENTIAL TREATMENT FOR POSTOPERATIVE VENTRAL HERNIA OF LATERAL ABDOMEN PARTS Russian patent published in 2006 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: method involves selecting aponeurotic and muscular abdominal wall layers from cicatricial adhesions in the hernial gates vicinity, separated from each other and from the abdominal wall and 3-4 cm far from gate edges. Frontal sheath leaflet aponeurosis of the direct abdominal muscle is cut beginning from medial hernial gates angle to white line at an angle of 110-120° to long component of the hernial gates. The angle is cranially open in iliac hernia cases and caudally open in subcostal hernia cases. The direct abdominal muscle sheath leaflets are separated upward and downward to 3 cm far from underlying direct muscle. Two U-shaped sutures are placed on lateral edge of sheath aponeurosis so that the lower edge is to lie on the upper one in cranially open angle case and the upper edge is to lie on the lower one in caudally open angle case with 3 cm large duplication being formed. Isolated interrupted sutures are placed on the duplication. Force required for bringing abdominal wall layers close is measured in hernial gates vicinity. The force being not greater than 3.5 kg in aponeurosis cases and than 1 kg in muscle cases, skin flap is placed under external oblique muscle aponeurosis. The skin flap is fixed with piercing sutures to the aponeurosis 3-4 cm far from hernial gates edges. The aponeurosis is edge-to-edge sutured above the flap. The force being greater than 3.5 kg in aponeurosis cases and than 1 kg in muscle cases, polypropylene net, cut on hernial gates size, is additionally placed between the peritoneum and muscle layer. The net is fixed with piercing sutures tied under the aponeurosis. The aponeurosis is sutured without tension to the flap along hernial gates edge.

EFFECT: biomechanical abdominal wall properties taken into account; prevented hard morphologic muscle changes.