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Year 2012 Vol. 20 No 5
GENERAL AND SPECIAL SURGERY
M.V. KUKOSH, A.V. VLASOV, G.I. GOMOZOV
PREVENTION OF EARLY POSTOPERATIVE COMPLICATIONS AT ENDOPROSTHESIS OF VENTRAL HERNIAS
State Budgetary Educational Establishment of Higher Professional Education “Nizhny Novgorod State Medical Academy”,
The Russian Federation
Objectives. To analyze the early postoperative complications at the endoprosthesis of ventral hernias.
Methods. The treatment results of 245 patients with ventral hernias, who were operated on using mesh synthetic endoprostheses are presented. Endoprosthesis fixation in the position “on-lay” was performed in 220 (90%) patients, in the position “sub-lay” – in 21 (9%), in the position “in-lay” in 4 (1%). To prevent the wound complications using the “on-lay” and “in-lay” methods in the main group (n=122) aponeurosis was sewed on and fixed with the vertical P- stitches to the prosthesis and the bottom of the wound. The wound drainage was performed in 4 patients (3,3%). In the control group (n=102) we carried out drainage and wound layer-wise stitch without wide taking and fixation of subcutaneous tissue. Drainage was made in 83 patients (81,4%).
Results. The application of the postoperative wound closure technique, at which wide taking and fixation of subcutaneous tissue to the prosthesis and the bottom of the wound by means of the vertical P- stitches as well as limiting of indications to the wound drainage has decreased the incidence of complications at the early postoperative period. In the main group the formation of clinically significant fluid accumulations was observed in 9 (7,4%) patients; in the control group – in 28 (27,5%) patients. Differences are statistically significant (p<0,001).
Conclusions. The main reasons of formation of fluid accumulations in the wound at endoprosthesis are the mobilization of subcutaneous tissue with vascular trauma, formation of “dead space”, absence of fixation and snug fit of tissue to the synthetic prosthesis. Wide taking and fixation of subcutaneous tissue to prosthesis and bottom of the wound with the help of vertical P- stitches according to “on-lay” and “in-lay” methods let us reduce the incidence frequency of clinically significant fluid accumulations at the early postoperative period.
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603001, Rossiyskaya Federatsiya, g. Nizhniy Novgorod, ul. Nizhne-Volzhskaya nab. 1/1, GBOU VPO «Nizhegorodskaya gosudarstvennaya meditsinskaya akademiya», kafedra fakultetskoy khirurgii,
Vlasov Aleksandr Viktorovich
Kukosh M.V. Doctor of Medical Sciences, Professor, Head of the Faculty Surgery Chair of SBEE HPE “Nizhny Novgorod State Medical Academy”.
Vlasov A.V. Assistant of the Faculty Surgery Chair of SBEE HPE “Nizhny Novgorod State Medical Academy”.
Gomozov G.I. Candidate of Medical Sciences, Head Doctor of SBME ND “City Clinical Hospital ¹7”, Associate Professor of the Faculty Surgery Chair of SBEE HPE “Nizhny Novgorod State Medical Academy”.