RESUMO
Myofascial defects of lateral abdominal wall and lumbar region occur chiefly after lumbotomy--the most popular access in urosurgery. Meanwhile lumbotomy remains one of the most traumatic accesses through the lateral abdominal wall. Myofascial defects were diagnosed in 48,9% of operated patients with lumbotomy. Of them true postoperative hernias were found in 35,3%; neuropathic hernias - in 13,6%. Since 2002 the originally developed method of lateral abdominal wall reconstruction had been used for the treatment of such patients. The immediate and long-term results (maximal follow-up period 5 years) showed no hernia recurrence or complications in 26 operated patients.
Assuntos
Parede Abdominal/cirurgia , Hérnia/diagnóstico , Região Lombossacral/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Feminino , Seguimentos , Hérnia/etiologia , Hérnia Abdominal/diagnóstico , Hérnia Abdominal/etiologia , Hérnia Abdominal/cirurgia , Herniorrafia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
One hundred and twenty-one patients with postoperative abdominal hernias of different size and location were treated, 103 of them underwent surgery with polypropylene endoprosthesis. Size of hernia was objectively assessed with an original method of X-ray-computed hernioabdominometry. The parameter presents as percentage of relative volume of hernia. Based on this index, hernias were classified by size in the following way: small -- relative volume 1.0 - 5.0%, middle-sized -- 5.1 -14,0%, large -- 14.1 - 18%, gigantic -- over 18.0%. Choice of a hernioplasty method depended on relative volume of postoperative hernia. Middle-sized hernias were indications for reconstructive surgery (complete adaptation of muscular and aponeurotic layers of abdominal wall), gigantic hernias - for correcting surgery (specified diastasis of muscular and aponeurotic layers was maintained). In large hernias the method of hernioplasty was individual depending on compensatory abilities of the patient. Postoperative complications (6.6%) were local and seen in 6.6% cases. There were no lethal outcomes and complications associated with endoprosthesis. Recurrences of hernia were not revealed in all 103 patients examined from 6 months to 2.5 years after surgery.
