METHOD FOR SURGICAL MANAGEMENT OF LARGE AND GIANT INCISIONAL VENTRAL HERNIAS Russian patent published in 2024 - IPC A61B17/00 A61B17/04 A61F2/90 

FIELD: medicine; surgery.

SUBSTANCE: two endoprostheses are installed in different layers of an anterior abdominal wall: a composite endoprosthesis with an anti-adhesive coating and a mesh endoprosthesis made of polypropylene. Composite endoprosthesis It is placed intraperitoneally and fixed with four transfascial sutures to the anterior abdominal wall: the first suture is placed in the upper part of the composite endoprosthesis, the second suture is in the lower part of the composite endoprosthesis, the third and fourth sutures are in the right and left parts of the composite endoprosthesis. Edges of the composite endoprosthesis are sutured to the anterior abdominal wall with a continuous suture along the perimeter of the endoprosthesis, consisting of four sections between the transfascial sutures, with placement of sutures between intraperitoneally located composite endoprosthesis and peritoneum. Continuous suture is formed starting from the needle sticking into the peritoneum from the side of the abdominal cavity next to the already applied transfascial suture. Needle is delivered from top to bottom, capturing only the peritoneum. After puncturing from the peritoneum, the composite endoprosthesis is pricked in at a distance of not less than 0.5 cm from its edge, needle is delivered through the composite endoprosthesis into the abdominal cavity towards its center. Needle is pricked out at distance of 1 cm from the prick on the outer part of the composite endoprosthesis not coated with an anti-adhesive coating. Knot is tied between external part of endoprosthesis and parietal peritoneum, at the same time the suture is left for continuation of continuous suturing in the same way at the next section between transfascial sutures. Further, a continuous suture is performed towards the next transfascial suture along the perimeter of the endoprosthesis. After the composite endoprosthesis is installed, the hernia orifice is closed above the first endoprosthesis using a hernial sac without tension, forming a bridge connection. Mesh endoprosthesis from polypropylene is inserted supraponeurotically with hemming of the latter with a continuous suture to surrounding tissues locally above the bridge connection point without wide mobilization of the subcutaneous fat flap at a distance of not more than 5 cm from the edges of the hernia orifice. Fixation of mesh endoprosthesis from polypropylene is performed by continuous sutures in two rows along perimeter of this mesh endoprosthesis.

EFFECT: method enables closing the hernia orifice in large and giant postoperative hernias of the anterior abdominal wall without a significant increase in intra-abdominal pressure, reducing the frequency of recurrences, reduce the rate of local postoperative complications and chronic pain syndrome, prevent migration of intestinal loops into the space between the endoprosthesis and the anterior abdominal wall, as well as prevent the development of compartment syndrome.

1 cl, 7 dwg, 1 ex