RU-2861537-C1 - METHOD FOR TREATING PARASTOMAL HERNIA

RU2861537C1RU 2861537 C1RU2861537 C1RU 2861537C1RU-2861537-C1

Abstract

FIELD: medicine; surgery; herniology. SUBSTANCE: in patients with parastomal hernias, incising the anterior wall of the rectus abdominis sheath or the external oblique abdominal muscle from the aponeurotic part onto the muscle part at a distance of 2.0 cm from the edge of the hernia orifice. The formed musculoaponeurotic flaps are unfolded around the hernia orifice and sutured together to the intestinal wall forming the stoma, covering the hernia orifice and the intestinal wall to a height of 1.5 cm. The musculoaponeurotic flaps are sutured to the intestinal wall, forming a musculoaponeurotic ring around the intestine. The plasty area is reinforced with a mesh implant with an opening, the diameter of which is equal to the diameter of the intestine, and a cut connecting the opening to the outer edge of the implant. The intestine is inserted into the opening of the mesh implant through the cut. The edges of the cut of the mesh implant are sutured. The implant is placed on the anterior surface of the rectus abdominis muscle or the internal oblique abdominal muscle under the musculoaponeurotic ring formed by the flaps, around the hernia orifice. The outer edge of the mesh implant is sutured to the anterior surface of the rectus abdominis muscle or the internal oblique abdominal muscle, and the edges of the opening of the mesh implant are sutured to the musculoaponeurotic ring. EFFECT: closure of the hernia orifice in patients with parastomal hernias with tissues of the anterior wall of the rectus abdominis sheath or tissues of the aponeurosis of the external oblique abdominal muscle, reducing the risk of migration of the mesh implant and integration of the mesh implant into the intestinal wall, reducing complications. 1 cl, 3 dwg, 1 ex

Inventors

BELOKONEV VLADIMIR IVANOVICH
Pushkin Sergei Iurevich
Gubskii Vladislav Mikhailovich
Kuper Vasilisa Dmitrievna
Pikovskii Oleg Igorevich
Mkrchan Armen Babketovich

Dates

Publication Date: 20260505
Application Date: 20250729

Claims (1)

A method for treating a parastomal hernia characterized by closing the hernial orifice with tissues of the anterior wall of the rectus abdominis sheath or tissues of the aponeurosis of the external oblique abdominal muscle: the anterior wall of the rectus abdominis sheath or the external oblique abdominal muscle is dissected from the aponeurotic part with the transition to the muscular part at a distance of 2.0 cm from the edge of the hernial orifice, the formed muscular-aponeurotic flaps are deployed around the hernial orifice and sutured together to the intestinal wall forming the stoma, covering the hernial orifice and the intestinal wall along the height at a distance of 1.5 cm, the muscular-aponeurotic flaps are sutured to the intestinal wall, forming a muscular-aponeurotic ring around the intestine; After this, the plastic area is reinforced with a mesh implant with an opening whose diameter is equal to the diameter of the intestine, and an incision connecting the opening with the outer edge of the implant: the intestine is inserted into the opening of the mesh implant through the incision, then the edges of the incision of the mesh implant are sutured, the implant is placed on the anterior surface of the rectus abdominis muscle or the internal oblique muscle of the abdomen under the muscular-aponeurotic ring formed by flaps, around the hernial orifice; the mesh implant is fixed: its outer edge is sutured to the anterior surface of the rectus abdominis muscle or the internal oblique muscle of the abdomen, and the edges of the opening of the mesh implant are sutured to the muscular-aponeurotic ring.

Description

Parastomal hernias are a pressing surgical problem [1]. The incidence of this complication reaches 54–58% and develops regardless of the stoma type (end, loop, ileostomy, and colostomy) [2, 3]. For the prevention and treatment of parastomal hernias during hernioplasty, the European Hernia Society recommends the use of synthetic non-absorbable mesh implants [4]. Field of technology to which the invention relates The invention relates to medicine, namely to surgery and herniology, and can be used to treat patients with parastomal hernias. State of the art A method for repairing parastomal hernias using a mesh implant is known, according to patent WO2009071998. This method involves the use of a mesh implant consisting of a two-layer composite mesh, one layer of which is absorbable and designed to grow into adjacent tissue. The absorbable layer is made of a biocompatible material. The mesh implant has a central opening for the stoma [5]. Disadvantages of this method include a high risk of mesh implant infection due to the synthetic material used, as well as the development of a foreign body sensation in patients during the postoperative period. A known method for repairing parastomal hernias, including those involving parastomal hernias, uses a mesh implant, according to patent RU 101921 U1, which is a warp-knit mesh made of synthetic threads [6]. This method also has several drawbacks. Firstly, performing parastomal hernia repair using this method does not guarantee the absence of hernia recurrence. Secondly, the mesh implant may cause a foreign body sensation in patients postoperatively. Furthermore, the synthetic mesh implant used has a traumatic effect, damaging the subcutaneous fat tissue prepared in the repair area, contributing to the formation of seromas. A known method of plastic surgery is the "keyhole" method, first proposed by B.M. Hansson et al. in 2003. The essence of the method lies in the installation of a mesh implant with a circular opening with a diameter of 2.5 - 3.0 cm, connected to a longitudinal incision running from the edge of the implant, after preliminary treatment of the hernial sac and suturing of the hernial orifice. In this case, the mesh implant is installed so that the longitudinal incision on it is located on the side opposite the hernial orifice in relation to the intestine forming the stoma. The result is closure of the abdominal wall defect and the creation of a keyhole-like structure around the intestinal loop forming the stoma [7]. The advantage of this method is its efficiency and technical simplicity. We have chosen this method of treating parastomal hernias as a prototype due to its closest technical essence. However, this method has a number of disadvantages. The disadvantages of this method include: placement of the mesh implant for its fixation on the aponeurosis, which complicates its integration into the tissues of the abdominal wall; suturing the edge of the prosthesis to the intestinal wall, which can lead to the formation of a pressure ulcer and intestinal fistula; placement of the prosthesis on the sutured hernial orifice when the applied sutures cut through leads to detachment of the prosthesis from the fixation site and the development of a hernia recurrence. This method of treating parastomal hernia is taken as a prototype. Disclosure of invention The aim of the invention is to develop a method for treating parastomal hernias that eliminates contact between the synthetic prosthesis and the intestinal wall where the fistula is forming, and reduces the risk of hernia recurrence due to rupture of the hernial orifice and detachment of the prosthesis from its tissue attachment site. This goal is achieved as follows. A mesh implant is used as an endoprosthesis for the plastic surgery. After isolating the intestine used to form the stoma, the anterior layer of the rectus sheath aponeurosis, the rectus sheath aponeurosis, or the external oblique aponeurosis is incised around the intestine at a distance of 2 cm from the hernial orifice. The medial flaps of the aponeurosis edges are then rotated 180 degrees and sutured together, narrowing the hernial orifice to the intestinal wall. A circular opening is then created in the synthetic implant, connecting to a longitudinal incision through which the implant is inserted around the intestine. The edges of the linear incision on the implant are sutured with a non-absorbable polypropylene thread 2.0, covering the hernial orifice and the intestinal wall along the height at a distance of 1.5 cm, and the prosthesis is placed under the medial aponeurosis flaps in such a way that it does not directly contact the intestinal wall, suturing it to the medial aponeurosis flaps along the perimeter of the small diameter, and then to the lateral aponeurosis flaps along the perimeter of the large diameter, using continuous threads made of absorbable material based on polyglycolide. Implementation of the invention The essence of the propos