Rationale for port-site hernias prevention after laparoscopic cholecystectomy
Journal Title: Хірургія України - Year 2018, Vol 0, Issue 2
Abstract
The aim — to substantiate and develop methods for the paraumbilical port‑site hernias prevention area during laparoscopic cholecystectomy based on the morphological state of the aponeurosis and the paraumbilical area muscles. Materials and methods. The treatment results of 56 patients aged from 30 to 75 years (mean age was 56.2 ± 1.5 years) with acute calculous cholecystitis after laparoscopic cholecystectomy have been analyzed. All patients showed the diastasis of the rectus abdominal muscles as a gap of 2 — 3 cm in width. Depending on the method of port‑site wounds closure, patients were divided into 3 groups: group I — 30 patients, examined during laparoscopic cholecystectomy, group II — 30 patients with paraumbilical port‑site hernias of the paraumbilical area after laparoscopic cholecystectomy, group III (comparison) — 20 patients who underwent upper‑median laparotomy. Results and discussion. After 48 months hernias were observed in 7 (24.1 %) in group I patients, whereas was no port‑site hernias in group II patients. Based on the results of the morphological study, 21 (70 %) patients of group I with diastasis of the rectus abdominal muscles in the paraumbilical region of 2 — 3 cm in size and all group III patients had moderately expressed muscle and aponeurosis atrophy; the severe muscle and aponeurosis atrophy, connective tissue area, uneven collagen fibers distribution, collagen fibers lysis, foci of lipomatosis were revealed in group II patients. Conclusions. The diastasis of the rectus abdominal muscles in paraumbilical area and the use of trocars in laparoscopic cholecystectomy are potentially provoking factors for the port‑site hernias development in the late postoperative period. One of the effective port‑site hernias preventing methods after laparoscopic cholecystectomy can be considered elimination of diastasis recti with fixation of the pre‑peritoneally placed mesh implant.
Authors and Affiliations
Ya. P. Feleshtynskyi, V. А. Dadayan
Keywords
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- EP ID EP359176
- DOI 10.30978/SU2018244
- Views 105
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