METHOD FOR TREATING POSTOPERATIVE LARGE AND GIANT VENTRAL HERNIAS

摘要

A method for treating postoperative large and giant ventral hernias comprises the closure of the hernial defect with the polymeric implant. The old postoperative cicatrix is dissected. When skin-fat apron is present, the surgery is supplemented with abdominoplasty. The hernial sac and the edges of aponeurosis are separated, the hernial sac is cut in the center, the adhesions between the hernial sac, the greater omentum and other abdominal organs are dissected. The abdominal organs are explored. When necessary, the pathology of the abdominal organ is corrected. The granulomas, old ligatures and the areas of the fat are removed from the parts of the hernial sac. One side of the sheath of rectus muscle of abdomen is opened throughout the wound defect mobilizing its posterior leaf at the distance at least 5 cm from the edge of the hernial orifice. The mobilized half of the hernial sac is sutured with non-interrupted or interrupted suture to the peritoneum of the opposite side of hernial defect at the distance at least 5 cm lateral to the edge of aponeurosis using non-resorbable threads. The internal leaf of the sheath of rectus muscle of abdomen or muscular-aponeurotic layer of the abdominal wall through its full thickness is involved into the suture. Polypropylene implant is tailored matching the shape of the defect of aponeurosis with 5 cm overmeasure in the edges. The implant is sutured with non-interrupted or interrupted suture along the preceding suture of the piece of the hernial sac and reinforced with the second row of the sutured along the edge of aponeurosis. On the other side, the implant is fixed to posterior leaf and muscular layer with two-row suture. The half of the hernial sac is sutured over the mesh to the upper leaf of aponeurosis of rectus muscle of abdomen. All the pouches of subcutaneous fat and skin are sutured. The wound is drained with double perforated tubular drainages with active aspiration.