310 Mira Street, Stavropol, Russia, 355017
+7 8652 352524; +7 8652 353229.
+7 8652 352524.
The journal is included into The list of leading scientific periodicals.
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.
1. Izmajlov S. G., Bodrov A. A. Method of suturing median laparotomy wounds. Hirurgija. – Surgery. 2005;7:28-32. (In Russ.).
2. Kuznecov N. A., Schastlivcev I. V., Caplin S. N. The role of the surgical approach in the development of postoperative ventral hernias. Hirurgija. – Surgery. 2011;7:62-67. (In Russ.).
3. Zatsarinnyi A. V., Budarev V. N., Murav’ev S. Iu., Avdeev S. S., Vornachev S. A. [et al.]. Results of functionally oriented operations in herniology. Nauka molodih (Eruditio Juvenium). – Science of young (Eruditio Juvenium). 2013;3:34-43. (In Russ.).
4. den Hartog D., Dur A. H., Kamphuis A. G. Comparison of ultrasonography with computed tomography in the diagnosis of incisional hernias. Hernia. 2009;13(1):45-48. https://doi.org/10.1007/s10029-008-0420-y
5. Dur A. H., den Hartog D., Tuinebreijer W. E. Low recurrence rate of a two-layered closure repair for primary and recurrent midline incisional hernia without mesh. Hernia. 2009;13(4):421-426. https://doi.org/10.1007/s10029-009-0487-0
6. Sultangaziev R. A., Bebezov H. S., Nurmanbetov D. N., Abirov K. Je., Togochuev A. A. Operating access and method of suturing the anterior abdominal wall in patients with portal hypertension. Vestnik KRSU. – Herald of KRSU. 2015;15(7):146-148. (In Russ.).
7. Georgiev-Hristov T., Celdrán A. Comment to: A systematic review of the surgical treatment of large incisional hernia. Hernia. 2015;2:89-101. https://doi.org/10.1007/s10029-015-1417-y
8. Fedoseev A. V., Murav’ev S. Iu., Budarev V. N. Iniutin A. S., Zacarinnyj V. V. Some features of the linea alba as harbingers of postoperative hernia. Rossijskij mediko-biologicheskij vestnik imeni akademika I. P. Pavlova. – I. P. Pavlov Russian Medical Biological Herald. 2016:1:109-115. (In Russ.).
9. Llaguna O. H., Avgerinos D. V., Lugo J. Z. Incidence and risk factors for the development of incisional hernia following elective laparoscopic versus open colon resections. Am. J. Surg. 2010;199 (2):263-265.
10. Millbourn D., Cengiz Y., Israelsson L. A. Effect of stitch length on wound complications after closure of midline incisions: a random ized controlled trial. Arch. Surg. 2009;144(11):1056-1059. https://doi.org/10.1001/archsurg.2009.189
11. Rahbari N. N., Knebel P., Diener M. K. Current practice of abdominal wall closure in elective surgery. Is there any consensus? BMC Surg. 2009;15(9):8. https://doi.org/10.1186/1471-2482-9-8
12. Yurasov A. V. The choice of method of plastic postoperative ventral hernias. Annaly hirurgii. – Annals of Surgery. 2010;6:23-27. (In Russ.).
Keywords: postoperative hernia, aponeurosis, prophylactic, continuous suture