Reconstrucţia peretelui abdominal prin tehnici de separare a componentelor &icirc;n tratamentul herniilor incizionale de mari dimensiuni

Bour Alin; Targon Roman; Dima A.; Racoviţă Vasile; Vrabie Artur; Cazacu Lilian; Potlog Fiodor

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617.55-007.43-089-06 (1)

Științe medicale. Medicină (11438)

SM ISO690:2012

BOUR, Alin, TARGON, Roman, DIMA, A., RACOVIŢĂ, Vasile, VRABIE, Artur, CAZACU, Lilian, POTLOG, Fiodor. Reconstrucţia peretelui abdominal prin tehnici de separare a componentelor în tratamentul herniilor incizionale de mari dimensiuni. In: Arta Medica , 2019, nr. 3(72), pp. 15-16. ISSN 1810-1852.

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Arta Medica

Numărul 3(72) / 2019 / ISSN 1810-1852 /ISSNe 1810-1879

Reconstrucţia peretelui abdominal prin tehnici de separare a componentelor în tratamentul herniilor incizionale de mari dimensiuni

The abdominal wall reconstruction through components’ separation techniques for large incisional hernia repair

CZU: 617.55-007.43-089-06

Pag. 15-16

Bour Alin¹, Targon Roman², Dima A.², Racoviţă Vasile², Vrabie Artur², Cazacu Lilian¹, Potlog Fiodor²

¹ Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“,
² Spitalul Clinic Militar Central

Disponibil în IBN: 6 februarie 2020

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Introducere: Managementul chirurgical al herniilor incizionale gigante reprezintă o problema provocatoare şi complexă. Reconstrucţia peretelui abdominal prin procedee de separare a componentelor completată cu augmentarea protetică şi restaurarea liniei albe reprezintă o nouă direcţie în cura chirurgicală a eventraţiilor. Materiale și metode: În perioada septembrie 2017- mai 2019 am aplicat procedeul la 9 pacienţi (6 de sex masculin) cu hernii ventrale incizionale de mari dimensiuni. Dimensiunea medie a lăţimii defectului parietal a constituit 14 cm (interval 12,5- 19,5 cm).Repartiţia herniilor conform clasiicării EHS (2009): M1W3 (n=2), M2W3 (n=2),M3W3 (n=2), M5 W3 (n=2 ) și L2W3 (n=1). Tehnica de separare anterioară a componentelor O. Ramirez completată cu plasarea protezei DynaMesh®IPOM a fost realizată la 5 pacienţi. Separarea posterioară a componentelor cu eliberarea muşchiului transvers abdominal (TAR) şi montarea plasei chirurgicale HERNI PRO P2 a fost realizată la 4 pacienţi. Rezultate: Complicaţii parietale au fost instalate la 3 pacienţi. Timpul mediu de urmarire a fost 11 luni fără recidivă. Concluzii: Tehnici de separare a componentelor oferă soluţia delicată pentru tratamentul eventraţiilor voluminoase şi asigură restabilirea funcţionalităţii peretelui abdominal

Introduction: Giant incisional hernia repair is a complex and challenging issue. Modern reconstructive techniques are based on component separation augmented by prosthetic mesh. The recreation of linia alba represents a novel approach to ventral hernia repair. Materials and methods: Between September 2017 and May 2019 we used the component separation techniques in 9 patients (6 males) with giant ventral incisional hernias. The average width of the defect was 14 cm (range 12,5- 19,5 cm). According to EHS (2009) classiication, the groin hernias were classiied as type M1W3 (n=2), M2W3 (n=2), M3W3 (n=2), M5 W3 (n=2) și L2W3 (n=1). The anterior components separation technique (ACST) was used in 5 patients. ACST was realized by sliding the myofascial rectus lap and placement of prosthetic DynaMesh®IPOM mesh in intraperitoneal position. Posterior component separation with transvers abdominis muscle release (TAR) and HERNI PRO P2 mesh placement in a sublay fashion was used in 4 patients. Results: We observed 3 cases of various types of wound complications. Patients were evaluated at a median follow up of 11 month without recurrence. Conclusions: Modern reconstructive techniques based on component separation ofer a solution for successful hernia management and provide high-level functionalityof the abdominal wall.

Cuvinte-cheie
hernie incisională gigantă, separarea posterioară a componentelor, eliberarea transversului,

giant incisional hernia, posterior separation of the components, transvers abdominis muscle release

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