Correction of a connective tissue dysplasia in the treatment of postoperative abdominal hernias

There were analyzed the results of treatment of 112 patients, suffering postoperative abdominal hernia, in whom the anterior abdominal wall alloplasty was performed as well as postoperative pathogenetically substantiated complex therapy, taking into account the presence of a connective tissue dysplasia syndrome (CTDS) and the early and late postoperative complications prophylaxis. The peculiarities of postoperative period course and late follow-up results were studied up. Phenotypic features of CTDS were revealed in 53 (47.3%) patients, immunohistochemical features of a connective tissue dysplasia (a failed collagen type I and III ratio, manifested by increase of a collagen type III fibers quantity in 3 or more times) were revealed in 78 (69.6%) patients, in whom the processes of a collagen and its supermolecular formations synthesis were stimulated, using a magnesium orotate (Magnerot), which was prescribed in 1 g dose twice a day during 4 - 6 weeks. Application of composite nets, owing big pores, in a complex with a postoperative pathogenetically substantiated therapy conduction have positively influenced the disease course and the late follow-up results achieved.     

The role of connective tissue nonspecific dysplasia in postoperative and recurrent abdominal hernias formation

There were studied the rate of clinical indices diagnosis concerning nondifferentiated form of connective tissue dysplasia (NFCTD) as well as their significance in postoperative and recurrent abdominal hernias formation in 61 patients, ageing 20 - 78 years. It was established, that in 77% of patients the hernia have had formated on a NFCTD background, including in 16.4%--with a mild degree, in 27.8%--moderate degree and in 32.8%--a severe one. The authors recommend while abdominal hernia is present to study a characteristic phenotypical signs of a connective tissue dysplasia and, if more than 4 signs are diagnosed, to prefer the application of alloplastic methods.     

Peculiarities of treatment of patients, suffering postoperative peritonitis, complicated by abdominal sepsis

In 2001-2011 yrs 241 patients, 18-80 years old, including 148 (61.4%) men and 93 (38.6%) women, were treated in the clinic f postoperative peritonitis. In 156 (64.7%) patients abdominal sepsis was diagnosed. In 74 (83%) patients a puncture-draining interventions were performed under ultrasonographic control for local postoperative peritonitis, and relaparotomy - in 15 (16.9%). In 18 (11.8%) patients, suffering extended peritonitis, miniinvasive technologies were applied. For extracorporal detoxication in 96 (40%) patients the intermitting veno-venous hemodiafiltration was conducted as well as plasmapheresis, peritoneal dialysis. As a result of polyorgan insufficiency development 34 (14.1%) patients died, of them after miniinvasive interventions - 5 (5.4%).     

Rehabilitation and the quality of life estimation in patients suffering postoperative abdominal hernia before and after performance of reconstructive operation

The modern approach to rehabilitation and the quality of life securing in patients suffering postoperative abdominal hernia was elucidation. Using the rehabilitation algorrhythm elaborated in 69 (88.5%) patients suffering extent and giant hernia, satisfactory result was achieved after reconstructive operation performance, which had guaranteed the sufficient quality of life level. Poor result was noted in 9 (11.5%) patients, of them in 4 (5.1%) the disease recurrence had occurred, 5 (6.4%) were directed to expert medico-social commission. In these patients the quality of life indices did not differ from their values, presenting before the operation.     

Surgical treatment of postoperative abdominal hernia

After surgical treatment of 664 patients with postoperative abdominal hernias (PAH) within the period of from 1972 to 1983, the incidence of recurrences was 48.4%. On the basis of studying microcirculation at the area of hernioplasty and its dependence on tissue tension force in the experiment on animals and at operations by means of radiometry, rheometry and fluorimetric analysis, the technique for surgical treatment of PAH with regard to location of a defect, including the method of plasty, system of preoperative preparation and prophylaxis of the postoperative wound complications, has been developed. From 1984, 200 patients with PAH were operated on, the incidence of recurrences decreased to 2.4%.     

The treatment of postoperative abdominal hernia

The results of treatment of 67 patients with postoperative abdominal hernia were analyzed. Approach to the choice of method and volume of operative intervention was proposed.     

The treatment of postoperative abdominal hernia

The experience with treatment of 450 patients with postoperative abdominal hernias with the use of autodermal plasty is presented. The incidence of hernia recurrences achieves 27.2%, lethality--1.6%.     

Alloplasty of giant postoperative abdominal hernia in middle aged and aged patients]

Surgical treatment of giant postoperative abdominal hernia was performed in 73 patients aged 63-73 yrs using additional plastic materials (polyurethane, polypropylene). The combined hernioplasty without stretching of tissues with disposition of implant in the hernial sac duplication was performed in 57 (78.1%) patients, in whom the abdominal wall defect revealed was 151-200 cm2; hernioplasty, forming artificial abdominal wall from the duplicated implant without reducing of the abdominal cavity volume--in 16 (21.9%) patients, in whom the hernial defect exceeded 200 cm2. An acute pulmonary-cardiac insufficiency had occurred in 2 (2.7%) of patients. One patient died. Recurrent hernia after the combined hernioplasty performance had occurred in terms from 1 to 5 years in 1 (1.9%) patient.     

阑尾切除术后腹壁切口疝的超声诊断

目的：探讨彩色多普勒超声对阑尾切除术后腹壁切口疝的诊断价值。方法回顾性分析2008年6月至2012年12月,首都医科大学附属北京朝阳医院京西院区收治阑尾切除术后经超声诊断为腹壁切口疝患者52例,观察其腹壁超声图像解剖特点并进行总结。结果腹壁网膜嵌顿疝11例,腹壁膨出疝6例,腹壁滑动疝35例,52患者均经手术证实。结论多普勒超声对阑尾术后腹壁切口疝的诊断有很高诊断价值。     

Results of surgical treatment of postoperative abdominal hernia

There were examined 525 patients with postoperative abdominal hernia, in 47.3% of them big, vast and giant hernia was revealed. There were operated 436 patients using local tissues with duplicature formation--according to Mayo, Sapezhko, Napalkov and Yanov method.     

The prevention of the occurrence of complications in patients with a postoperative abdominal hernia

In 48 patients with postoperative abdominal hernia, oxygen therapy in the complex with therapeutic physical training was used 4 times a day for 15 min. The treatment resulted in elimination of hypoxemia, decrease in coagulative blood activity, normalization of the blood ABB, improvement of microcirculation. No postoperative complications were noted.     

Body wall dysplasia: a rare case of abdominal hernia

Malformations of the fetal abdominal wall include a broad spectrum of anomalies, and prenatal sonography provides the possibility of detecting most of them. Omphalocele and gastroschisis are the most common conditions, but there are other rare forms. We describe here a rare case of body wall dysplasia that we called abdominal hernia that appeared upon prenatal sonography as an omphalocele-like defect.