Hernia as Complication of Laparoscopic Interventions
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.
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