METHOD OF SURGICAL TREATMENT OF PARASTOMAL HERNIAS Russian patent published in 2023 - IPC A61B17/00 A61F2/02 

FIELD: medicine; coloproctology.

SUBSTANCE: invention is used in the surgical treatment of parastomal hernias. The hernial sac is opened and a segment of the intestine carrying the stoma is mobilized. The aponeurosis of the rectus abdominis muscle and the external oblique abdominal muscle is dissected along the entire circumference of the hernial orifice. In the avascular zone, the transverse abdominal muscle and the internal oblique abdominal muscle are separated. The aponeurosis of the internal oblique abdominal muscle is cut off from the aponeurosis of the transverse abdominal muscle upward to the edge of the costal arch, and downward — to the internal inguinal opening. Then the rectus abdominis muscle is separated from the posterior leaf of its vagina upwards to the previously planned place for the removal of the intestinal stoma. An incision is made in the skin, the anterior leaf of the sheath of the rectus muscle, and the muscle fibers are separated by a clamp in the vertical direction. On the anterior axillary line at the costal arch, the fibers of the transverse abdominal muscle are bred in the horizontal direction, and then the intra-abdominal fascia and peritoneum are dissected over an extent equal to the width of the mobilized intestine with the adjacent mesentery. Through the formed hole, the intestine carrying the stoma is passed. It is passed into the space between the transverse abdominal muscle and the internal oblique muscle of the abdomen, and then through the retromuscular space through the previously created hole in the rectus abdominis muscle to the skin of the anterior abdominal wall. The aponeurosis is sutured, restoring the semilunar line, a mesh implant is placed instead of the hernial ring. The wound is sutured in layers and a new intestinal stoma is formed.

EFFECT: method allows to avoid the formation of adhesions between the implant and intestinal loops, reducing the risk of recurrence by maintaining the integrity of the posterior leaf of the aponeurosis of the rectus and transverse abdominal muscles.

1 cl, 1 ex