THE CLINICAL-ANATOMICAL STUDY OF A NEW METHOD OF THE REDUCTION OF INTRAPERITONEAL PRESSURE AT PLASTIC PROSTHETIC OPERATIONS OF MIDDLE POSTOPERATIVE HERNIAS OF THE ANTERIOR ABDOMINAL WALL

We performed a topographic and anatomical study on 24 cadavers with signs of diastasis of the rectus abdominal muscles. The research consisted in studying the tension of the nodal suture superimposed on the edges of the previously dissected linea alba before and after performing various relaxing incisions of the aponeurotic structures of the anterior abdominal wall. In the experimental part of the work carried out on 5 rabbits of the chinchilla breed was investigated the possible intra- and postoperative complications during implementation of the proposed wavelike relaxing incision of anterior wall of rectus sheath. In the clinical study included 20 patients with incisional hernias. The patients were divided into main and control groups. In the main group (n=10) hernia repair was performed using the sublay method with a developed wavelike relaxing incision of anterior wall of rectus sheath, and in the control group (n=10) the operation was performed according to the classical technique. In a topographic anatomical study we found that the proposed wavelike relaxing incision of anterior wall of rectus sheath is 1,5 times more effectively reduces tension on the sutures in comparison with the classical methods. According to the results of experimental studies, a possible postoperative complication in using a wavelike relaxing incision of anterior wall of rectus sheath is a subcutaneous hematoma in the postoperative wound (20%).In a clinical study we found that intra-abdominal pressure in the main group was 11,7±0,6 mm hg.st. and 9,8±0,5 mm hg.st. during surgical intervention and day after, and in the control group was 14,2±0,5 mm hg.st. and 12,3±0,4 mm hg.st (p=0,05).Postoperative complications in the main group of study we were not observed. In the control group we observed postoperative complications in 20% in the early postoperative period (postoperative serous wound inflammation, intestinal paresis) and 40% in the late (chronic pain syndrome) postoperative period (p=0,05).

abdominal wall, ventral hernia, hernia repair

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