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indexed in Scopus
Year 2013 Vol. 21 No 1
N.V. ALEKSANDRENKOV 1, A.S. MYKHIN 2, V.A. REBCOVSKY 3, À.Å. LEONTEV 3
WOUND CLOSURE METHOD AT SUBAPONEUROTIC PLASTY WITH POLYPROPYLENE MESH OF LARGE POSTOPERATIVE VENTRAL HERNIA
SBME KR “Babyninsky central regional hospital”1, SBEE HPE “Nizhny Novgorod State Medical Academy” 2,
MEHC “City Clinical Hospital ¹39”, Nizhny Novgorod 3,
The Russian Federation
Objectives. To decrease the number of wound complications after subaponeurotic plasty of large postoperative ventral hernia by means of the designed method of the herniotomy wound closure.
Methods. Patients with postoperative ventral hernia were subdivided into 2 groups. In the control group A (31 patients) the vacuum drainages were left in the wound over the mesh and the skin was sewed with the nodal sutures; the drainages were removed 4-5 days afterwards. In the main group B (52 patients) the separated subcutaneous fat was fixed in several layers by thread to the aponeurosis through the mesh endoprosthesis. The wound was not drained. The skin was sewed with the intracutaneous suture. In both groups ultrasound examination of the wound was performed on the 2-5 and 8-12 day. In care of detection seromas exceeding 1 cm in width the puncture method was used.
Results. According to the ultrasound data, large seromas were revealed in 32,5% patients in the group A on 8-12 day. In group B they were detected in 5,7% operated patients. Their number remained unchanged one month afterwards in both groups despite the puncture method of treatment. Total number of the wound complications in groups A and B made up 41,9% and 17,3%, correspondently. Group A patients stayed in hospital within 10-22 days, 13,54±3,40 on the average, in group B they were discharged on 8-17 days. The average time of hospitalization was 10,96±2,01 days.
Conclusions. The wound closure over endoprosthesis at herniotomy according to the designed method 2 time reduces wound complications as well as reducen of patients’ hospitalization up to 2,5 days on the average. It is associated with the ability of small seromas to self-resolve without any treatment. Absence of the cavity drainage and the intracutaneous suture excludes the wound infection.
- Mirzabekian IuR, Dobrovol'skii SR. Prognoz i profilaktika ranevykh oslozhnenii posle plastiki perednei briushnoi stenki po povodu posleoperatsionnoi ventral'noi gryzhi [Prediction and prevention of wound complications after plastic abdominal wall of the postoperative ventral hernia]. Khirurgiia Zhurn im NI Pirogova; 2008(1):66–71.
- Toskin KD, Zhebrovskii VV. Gryzhi zhivota. Biblioteka prakticheskogo vracha [Abdominal hernia. Library of practitioners]. Moscow, RF: Meditsina; 1983. 240 p.
- Fedorov IV, Chugunov AN. Protezy v khirurgii gryzh: stoletniaia evoliutsiia [Prostheses in hernia surgery: centenary evolution ]. Gerniologiia. 2004;(2):45–52.
- Vasil'ev MN, Vaniushin PN, Grigor'ev KIu. Sposob alloplastiki bol'shikh ventral'nykh gryzh [Method of alloplastics of large ventral hernias]. Fundam Issledovaniia. 2010;(11):33–36.
- Volkov DE, Dobrokvashin SV, Izmailov AG. Prichiny gnoino-septicheskikh ranevykh oslozhnenii pri khirurgicheskom lechenii ushchemlennykh posleoperatsionnykh ventral'nykh gryzh [Causes of septic wound complications in the surgical treatment of strangulated postoperative ventral hernias]. Kazan Med Zhurn. 2006;87(5):341–45.
- De Vries Reilingh TS, van Geldere D, Langenhorst B, de Jong D, van der Wilt GJ, van Goor H, Bleichrodt RP. Repair of large midline incisional hernias with polypropylene mesh: comparison of three operative techniques. Hernia. 2004 Feb;8(1):56–9.
- Tsverov IA, Bazaev AV. Otsenka osnovnykh sposobov alloplastiki s tsel'iu optimizatsii lecheniia bol'nykh s posleoperatsionnymi ventral'nymi gryzhami [Assessment of the main methods of alloplastics to optimize the treatment of patients with postoperative ventral hernias]. Sovrem Tekhnologii v Meditsine. 2011;(2):73–76.
- Soler M, Verhaeghe PJ, Stoppa R. Polyester (Dacron mesh. In: Bendavid R. et al. (eds). Abdominal wall hernias principles and management. New York, US: Springer-Verlaj; 2001. p. 266–71.
- Neliubin PS, Galota EA, Timoshin A.D. Khirurgicheskoe lechenie bol'nykh s posleoperatsionnymi i retsidivnymi ventral'nymi gryzhami [Surgical treatment of patients with postoperative and recurrent ventral hernias]. Khirurgiia. Zhurn im NI Pirogova. 2007;(7):69–74.
- Zoltan Ia. Sicatrix optima. Operativnaia tekhnika i usloviia optimal'nogo zazhivleniia ran [Operative technique and the conditions for optimal wound healing]. Budapest, Hungary: AKADEMIAI KIADO; 1974. 173 p.
- Semenov GM. Khirurgicheskii shov [Surgical suture]. Saint-Petersburg, RF: Piter, 2001. 256 p.
- Obolenskii VN, Gorkush KN, Plotnikov AA. Modifikatsiia vnutrikozhnogo shva pri prolongirovannykh razrezakh [Modification of intracutaneous suture with prolonged cuts]. Rus Med Zhurn. 2010;18(17):1044. Available from: Rezhim dostupa: http://www.rmg.ru.
- Zarivchatskii MF, Iagovkin VF. Sravnitel'naia otsenka rezul'tatov operativnogo lecheniia bol'shikh i gigantskikh posleoperatsionnykh ventral'nykh gryzh [Comparative evaluation of surgical treatment results of large and giant postoperative ventral hernias].Vestn Khirurgii im II Grekova. 2005(6):33–37.
249210, Rossiiskaia Federatsiia, Kaluzhskaia oblast', Babyninskii raion, p. Babynino, ul. Molodezhnaia, d. 11, GBUZ KO «TsRB Babyninskogo raiona»,
Aleksandrenkov Nikolai Vladimirovich
Aleksandrenkov N.V. Head of the surgical service of SBME KR “Babyninsky central regional hospital”.
Mykhin A.S. MD, professor, head of the chair of surgery FPKV SBEE HPE “Nizhny Novgorod State Medical Academy of Ministry of Healthcare of Russia”.
Rebcovsky V.A. A senior clinical intern of the surgical department of MEHC “City clinical hospital ¹ 39”, Nizhny Novgorod.
Leontev A.E. PhD, a clinical intern of the surgical department of MEHC “City clinical hospital ¹ 39”, Nizhny Novgorod.