| 摘要 |
FIELD: medicine.SUBSTANCE: according to the first version, a rectangular round-cornered reinforced warp mesh endoprosthesis for ventral hernia repair is presented with using non-absorbable polypropylene monofilaments of different thickness; in its structure, it comprises a reinforced area formed immediately in the primary area and consisting of a central rectangular platform; strips fixing the platform position above the hernia defect extend perpendicularly from the middle of each side. The length of the fixing strip is related to the length of the endoprosthesis in the same direction as 1:3; a pair of the vertical fixing strips has a number of needle wales not less than 8; and the other pair of the horizontal fixing strips has a number of needle wales not less than 36 and these are formed of monofilaments of the primary area of the thickness of dand the additional monofilaments of the greater thickness d. A transition from the reinforced area to the primary area has one needle wale in the vertical direction and four wale lines in the horizontal direction formed of the monofilament of the primary area and the additional monofilament having the thickness determined by the relation d=(d+d)/2; the relation of a cell area of the primary, reinforced and transition areas makes 1:0.5:0.75. According to the second version, the endoprosthesis is similar to that according to the first version, but it uses non-absorbable polyvinylidene fluoride monofilaments. According to the third version, the endoprosthesis is made of non-absorbable monofilaments of different thickness, including polypropylene monofilaments; it comprises a reinforced area formed immediately in the primary area and consisting of a central rectangular platform; strips fixing the platform position above the hernia defect extend perpendicularly from the middle of each side. The length of the fixing strip is related to the length of the endoprosthesis in the same direction as 1:3. The pair of the vertical fixing strips has the number of needle wales not less than 8, and the other pair of the horizontal fixing strips has the number of needle wales not less than 36 and these are formed of polypropylene monofilaments of the thickness dand the additional polyvinylidene fluoride monofilaments of the greater thickness d. The transition from the reinforced area to the primary area has one needle wale in the vertical direction and four wale lines in the horizontal direction formed of the polypropylene monofilament of the primary area and the additional polyvinylidene fluoride monofilament of the thickness determined by the relation d=(d+d)/2. The relation of the cell area of the primary, reinforced and transition areas makes 1:0.5:0.75. A method for the ventral hernia repair involves skin incision and separation of the hernia sac and subcutaneous fat surrounding the hernia orifice, separation from the aponeurosis, closure of the aponeurosis defect with an uninterrupted non-absorbable synthetic monofilament suture covering the aponeurotic rectus sheath into the suture edge followed by the anterior abdominal wall repair with any of the above endoprostheses placed on the rectus sheath aponeuroses, and fixed with an uninterrupted non-absorbable synthetic monofilament suture. The rectangular platform of the reinforced area of the mesh endoprosthesis is arranged above the hernia defect; the pair of the vertical fixing strips with the number of needle wales not less than 8, along the abdominal line, and the pair of the horizontally directed fixing strips with the number of needle wales not less than 36 is perpendicular to the rectus muscles. The endoprosthesis is fixed by an uninterrupted suture at several stages starting from two horizontal sides of the rectangular platform of the reinforced area transforming to both sides of the vertically directed fixing strips; thereafter, one uninterrupted suture is used to fix the endoprosthesis full-width within the horizontally directed fixing strips to the rectangular platform of the reinforced area anchored to finish the fixation of the endoprosthesis to the uninterrupted suture along the perimeter.EFFECT: reducing rate of recurrences and postoperative complications ensured by improving the endoprosthesis fixation by forming a high-density connective tissue scar immediately in the hernia defect and in the areas of the vertically and horizontally directed strips which transform into a less dense scar within surrounding tissues in a combination with adjusting expansibility along the whole surface of the primary area and increasing elasticity, preserving the endoprosthesis strength within the hernia defect and reducing an amount of a foreign material implanted into the body.4 cl, 1 tbl, 4 dwg |
