Dadayan V. Features of Surgery and Prevention of Incisional Port-site Hernias

The dissertation is devoted to the solution of the actual problem of improving the results of surgical treatment and prevention of patients with postoperative port-site hernias by substantiation, development and improvement of methods of laparoscopic and open allogeneic plastics. The results of examination and surgical treatment of 116 patients with paraumbilical postoperative port-site hernias and 85 patients with gallstone disease who underwent prevention of port-site hernias during laparoscopic cholecystectomy in the period from 2013 to 2020. Age of patients from 30 to 75 years, mean age 53 ± 1.3 years. There were 82 women (61.2 %) and 34 men (38.8 %). It was determined that among the causes of postoperative port-site hernias of the paraumbilical area, where a 10 mm trocar is traditionally installed for laparoscopic cholecystectomy, 30 % have diastase of the rectus abdominis, which is accompanied by thinning of the white line aponeurosis, atrophy of the rectus abdominis port-site and creates the basis for the occurrence of a defect of the abdominal wall. Morphological structures of musculo-aponeurotic edges of paraumbilical trocar defects of the abdominal wall are characterized by distinction and fragmentation of collagen fibers with the formation of foci of sclerosis, which extends to the entire width and length of diastase of rectus muscles and justifies For port-site hernias with concomitant rectal diastase up to 5 cm, it is optimal to improve laparoscopic allogernioplasty with elimination of rectal diastase by transfascial sutures. For port-site hernias and rectal diastase more than 5 cm, open alloplasty "sublay" is optimal. Prevention of port-site hernias of the paraumbilical area during laparoscopic cholecystectomy is achieved by using the developed laparoscopic method, while the traditional suturing of the port-site paraumbilical wound in 14 % is accompanied by a trocar defect. Surgical treatment of port-site hernias using a differentiated approach to the choice of allogeneic plastics, developed laparoscopic techniques in comparison with traditional choices and techniques significantly improves treatment outcomes, the recurrence rate is reduced to 1.7 % vs. 10.3 %.