SOME TECHNICAL POSSIBILITIES FOR PREVENTION OF TROACAR HERNIA AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Grivenko S. G., Golomidov A. N., Kalinichenko A. P., Usmanova T. E.

The widespread introduction of laparoscopic operations in abdominal surgery and the minimization of complications from trocar wounds does not exclude the occurrence of postoperative trocar hernias (TH). A particularly high incidence of TH is observed after laparoscopic cholecystectomy (LCE) at the site of paraumbilical trocar placement. Purpose of the study: to analyze the results of surgical treatment of acute calculous cholecystitis and methods for preventing the occurrence of TH after LCE. Material and methods. A retrospective analysis of medical records of 116 patients who underwent LCE for acute calculous cholecystitis was carried out, followed by identification of methods for preventing their occurrence. Research results. When analyzing long-term results, there were no cases of TH occurrence in the study group of patients. This was facilitated by the introduction into clinical practice of developed methods for preventing the occurrence of TH in patients at risk, based on patented preventive prosthetic plastic surgery in the area of trocar wounds. The leading factors contributing to the development of TH in patients in this group were additional trauma to trocar wounds and possible infection of the tissues of the anterior abdominal wall. The proposed methods are low-traumatic, since there is no need for additional fixation of the mesh with separate interrupted sutures along its lateral edge, technically simple, reliable, since the proposed types of mesh fixation prevent its dislocation in any direction. Conclusion. The developed methods for preventing the formation of TH after endovideosurgical operations have shown their effectiveness and can be recommended as the final stage of LCE and other minimally invasive operations if the patient has risk factors for the formation of TH.

Keywords:prevention, troacar hernia, laparoscopic cholecystectomy, preventive prosthetic plasty