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Prevention of postoperative hernia in midline laparotomy

[Surgery]
Andrey Fedoseev; Vladimir Rybachkov; Aleksandr Inyutin; Sergey Lebedev;

The purpose of the study is to reduce the incidence of postoperative herniation during midline laparotomy. The study consisted of two phases. At the first stage, a prospective survey of 398 patients undergoing median laparotomy in 2013–2016 was performed. The type and level of operative access was evaluated, as well as the method of closing the laparotomic wound. The presence of aponeurosis defects (physically and by ultrasound), the presence of a hernial protrusion was detected. At the second stage, the strength of various sections of the white line of the abdomen and various types of sutures put on the aponeurosis were determined.
Most often, postoperative ventral hernias (PVH) developed after upper median access (p<0.05). The lowest frequency of herniation was obtained using a continuous suture (p<0.05). The middle part of the epigastric region of the white line of the abdomen has the lowest strength. A tensiometric study showed that a continuous suture was stronger than individual interrupted sutures (tSt=1.257; p<0.05). Thus, the epi-mesogastric segment of the white line of the abdomen is most vulnerable to the formation of postoperative hernias (tSt=–1,124; p<0.05). The use of a continuous suture reduces the incidence of postoperative hernia.

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Keywords: postoperative hernia, aponeurosis, prophylactic, continuous suture


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