Сеченовский вестник (Jan 2021)
Prevention of ventral hernias using a new technique for accessing the abdominal cavity through the midline of the abdomen with dissection of the navel and umbilical ring: comparison with traditional laparotomy
Abstract
The problem of postoperative ventral hernias remains relevant due to the high frequency of their development — in 7–24% of patients. Aim. To evaluate the effectiveness of prevention of postoperative ventral hernias using a new technique of access to the abdominal cavity in comparison with traditional laparotomy. Materials and methods. The proposed new technique of access to the abdominal cavity along the midline of the abdomen with dissection of the navel and umbilical ring was carried out in accordance with the method developed by us, registered by the patent of the Russian Federation. For the final analysis, 134 patients were selected, divided into group 1 (n = 67), in which the median access was performed using a new technique, and group 2, in which the traditional median access was performed with the left umbilical ring bypass (n = 67). The initial parameters of patients, characteristics during and after surgery were evaluated. The duration of follow-up after surgery was 24 months. Results. Groups 1 and 2 were comparable by gender, age, body mass index, and the presence of comorbidities. In 79% of patients in group 1 and in 67% of patients in group 2 (the difference is not significant), indications for surgery were malignancies of the abdominal cavity. The groups did not differ in the types of median laparotomy, the time of surgery, the amount of blood loss, the time of removal of postoperative sutures, and the duration of hospitalization. All patients were followed up for 24 months. Postoperative ventral hernia developed in one patient (1.5%) in group 1 and in 5 (7.5%) patients in group 2 within 12 to 24 months after surgery. There were no statistically significant differences in the frequency of hernia development (Mantel — Cox test, p = 0.100) Conclusion. A new method of median laparotomy in the treatment of patients with planned surgical pathology of the abdominal cavity is characterized by a low rate of postoperative hernia development.
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