Intraperitoneal plastics of postoperative and umbilical hernias

Abstract

The article describes a method of performing intraperitoneal plastics of umbilical and postoperative hernias, its technical features, as well as the evaluation of the performance of the proposed method, comparing it to previously proposed methods of classical hernia repair. Operation without the mobilization and removal of the hernia sac eliminates unnecessary trauma to the tissues, and thus reduces the number of postoperative complications. We open only the upper pole of the hernia sac, which serves as the entrance into the abdominal cavity. An intraperitoneal plastics was performed inside the hernia sac. The application of intraperitoneal plastics enabled operating with the smaller cuts. When choosing the length of the cut, the size of the hernia sac did not matter, but the size of the hernial orifice was important. Operation via the hernia sac cavity created quite a comfortable environment for the implementation of intraperitoneal plastics with a section corresponding to the size of the hernial orifice. During the surgery we avoided any contact endoprosthesis with subcutaneous fat. After fixation of the prosthesis, the layers of preserved hernia sac were stitched over it. In this case, the peritoneal surface of the hernia sac was de-epithelialized, and firm adherence of de- epithelialized peritoneum to the surface of the implant was created. This was important for the prevention of wound complications. The proposed method of muscular-aponeurotic plastics with endoprosthesis replacement creates the conditions of high mechanical stability combined with the properties of elastic decompression.