Hernia as Complication of Laparoscopic Interventions

М.І. Tutchenko, O.V. Vasylchuk, S.M. Piotrovych, O.V. Mamonov

Abstract


We have operated troacar hernia in 28 patients, aged 45–68 years old. All these patients previously underwent laparoscopic cholecystectomy, ranging from 1 to 3 years. In 26 patients (92.9 %) the hernia appeared in the periumbilical region, in 2 patients (7.1 %) — in the lateral abdominal wall area, the subhepatic drainage output area. In 16 patients (57.1 %) we observed purulent inflammatory complications in the periumbilical lesion area. The straight abdominal muscles diastasis of the 1st — 2nd degrees was diagnosed in 21 patients (75 %). During the operation, while establishing the periumbilical port, 2 patients (7.1 %) were noticed to have two defects of the abdominal linia alba.The absence of aponeurosis ligatures in 17 patients (60.7 %) evidences that the linia alba defect in the port positioning area wasn’t sutured during the first operation.
In operative intervention autoplasty after Sapezhko was performed in 3 patients (10.7 %) with hernia defects less than 2cm and preserved functioning straight abdominal muscles. In 25 patients (89.3 %) with present straight muscles diastasis and hernia defect larger than 3 cm, we preferred an autoplasty with polypropylene netlike implants. In 19 patients (76 %) hernioplasty by the sublay method was performed, in 6 patients (24 %) the network was performed preperionatally.
There were no complications in the postoperation period as well as recurrences of the hernia throughout 3 next years.
We consider that the hernia genesis after the laparoscopic cholecystectomy is caused by 2 main factor groups: general and local.
The general causes are:
— decreased functional capabilities of the straight muscles with their diastasis;
— age determined degeneration, weakness and atrophy of the aponeurosis structures with elasticity and regeneration loss.
The local causes are:
— inadequate suturing (or no suturing at all) of the anterior abdominal wall defect;
— purulent-inflammatory complication of the operation injury.


Keywords


troacar hernia; causes; prevention

References


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Оскертов В.И., Литвинов О.М., Скрипцина О.В. Основные причины возникновения троакарных гриж после видеолапароскопической холецистэктомии // Эндоскопическая хирургия. — 2007. — № 1. — С. 65-66.

Тоскин К.Л. Жебровский В.В. Грыжи живота. — М.: Медицина, 1983. — С. 184




DOI: https://doi.org/10.22141/1997-2938.2.21.2013.87514

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