There are many ways to treat hernias, however, the plastic surgery technique has always been associated with dissection of the skin and subcutaneous tissue. A known method of treating umbilical hernias according to Mayo. The disadvantage of this method is the rather large trauma associated with the need to dissect many tissues, including the aponeurosis. Roux’s method of treating inguinal hernia involves dissection of the skin and subcutaneous tissue. Without cutting the aponeurosis, sutures are applied to the aponeurosis, creating a fold of the aponeurosis. This method is also characterized by quite significant trauma and the associated possibility of postoperative complications.
The new method of treatment (Ukrainian invention patent No. 49856, dated 10.15.2002) is carried out as follows. After treatment of the operative field, one of the commonly accepted methods is to grasp the skin with pins in the upper and lower poles of the hernial protrusion under intravenous anesthesia in order to lift the skin and adjacent tissues (subcutaneous tissue, aponeurosis) up to avoid injury to the abdominal organs. To completely avoid the risk of damage to the internal organs of the abdominal cavity, retainer sutures are applied through the skin and with the capture of the adjacent aponeurosis using the Kocher probe. At the same time, the pins are removed, and the subsequent fixation of the hernia gate is done with retaining sutures.
After making point punctures of the skin with the tip of a sharp scalpel at a distance of 1-2 cm from the edge of the hernial gate, subcutaneous sutures are applied through the punctures with a synthetic suture material with a cutting needle, as well as with the capture of the front sheet of the sheath of the rectus muscle, 5 cm from the edge hernia gates on both sides. Seams are applied with a gap of about 1 cm from each other until the defect is completely eliminated. When tying the ligatures, the edges of the hernial gates are brought closer together, turning them inward, and the knots go deeper under the skin. A Kocher probe is used when applying and tying sutures. When tying the edges of the seams, the retaining seams are removed.
RESULTS AND DISCUSSION
This method of treatment was tested on 53 patients of various ages with diastasis of the white line of the abdomen, umbilical hernias. The observation period is 10 years. Complications in the postoperative period and recurrence were observed in one patient during observation. Most patients 10 years after the operation did not have any scars or other signs of the operation.
Due to the fact that the proposed method of herniaplasty provides elimination of the hernia gate without incision of the skin and subcutaneous tissue, it, firstly, ensures the least traumatization of the tissue, reduces postoperative pain syndrome, secondly, reduces the number of postoperative complications, thirdly, it creates a high cosmetic effect due to the absence of a postoperative scar on the skin.
- I.M. Matyashin, A.M. Gluzman. Handbook of surgical operations. / Kyiv “Health”. – 1979 – P. 246
- I.M. Matyashin, A.M. Gluzman. Handbook of surgical operations. / Kyiv “Health”. – 1979 – P. 248