Background. The introduction of the wide practice of laparoscopic operations is predetermined by their obvious advantages over laparotomic interventions, primarily minimization of the abdominal wall trauma and early rehabilitation. At the same time, the number of complications after laparoscopic surgery remains significant. One of the main complications is the formation of postoperative hernias, which significantly reduces the quality of life of patients.
Aim. The risk of postoperative hernia is defined by numerous local and systemic factors and appliances closing the abdominal wall.
Methods. During the period from 2009 to clinical bases of the Department of Surgical Diseases and new technologiesBashkiriaMedicalUniversity there were operated 23 patients with postoperative ventral hernias occurring after laparoscopic surgery. Among them, 19 were women and 4 — men. All patients aged 33 to 70 years. During the analysis it became clear that the greatest number of patients with postoperative ventral hernias is a group of patients (18 people) who had previously laparoscopic procedures. Subsequently, in a planned manner, all patients underwent hernia repair with plastic anterior abdominal wall mesh allograft in different versions. There were used polypropylene implants with prolene thread fixation with single interrupted sutures. At follow-up examination of patients up to 5 years after surgery, hernia recurrences were found.
Results. We concluded that usage of the tools of large diameter, wound infection in the area of trocar introduction and removing the organ or tissue removal, as well as poor suturing fascia at the site of the access cause prevention of herniation. As a precaution festering surgical wound we consider it necessary to avoid body removed contact with the subcutaneous tissue of the wound channel, as well as a requirement for antibiotic prophylaxis in patients operated on for acute surgical diseases. Taking into account the high risk of infectious complications in obese patients by surgical approach, during the evacuation of a removed organ, in order to avoid contact with the wound channel there is used 20 mm extender (RF patent for utility model number 58,893), which is installed in transumbilical point. After that, they remove expander with extractable organ. After desufflation polypropylene mesh explant cut out round with a diameter of 2 cm, which is placed on top of the fascia and fixed thereto 2–3 sutures. The final step is suturing the skin. This method was used in 73 patients with excessive and deep subcutaneous tissue. Note that the early postoperative period in all the patients was uneventful. Postoperative wounds in all patients healed by primary intention. In a study of the long-term period, up to 4 years after the surgery, in any case no trocar hernia was found.
Conclusion. The proposed method is effective and allows avoiding such complications in the postoperative period.