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DOI: http://dx.doi.org/10.20534/ESR-16-11.12-88-90
Karimov Shavkat Ibragimovich, Khakimov Murad Shavkatovich, Berkinov Ulugbek Bazarbaevich, Sattarov Oybek Tokhirovich (Tashkent Medical Academy) E-mail: doctoroybek84@mail.ru
Improvements to the selection of minimally invasive techniques in laparoscopic elimination diastasis rectal muscle of abdomen
Abstract: Objective. Assess the feasibility of laparoscopic elimination of diastasis recti and improve the results of treatment of such patients. Material and Methods. In 2 clinical TMA for the period from 2015 to 2016 performed 21 laparoscopic operations for diastasis recti II-III degree. Patients with diastase II degree was 9 (42.8%), with III — 12 (57.2%). The age of patients ranged from 36 to 62 years. 58% of patients were older than 50 years. Men were 7 women — 14 patients. In 7 patients had a concomitant pathology requires simultaneous operations: 4 — cholelithiasis, 3 — inguinal hernia. Results. Laparoscopic elimination of diastasis sheathe made under anesthesia. When laparoscopy determined the boundaries of diastasis recti. The operation was carried out with the help of endoscope developed by us, "the hook-needle" Mean operative time was 52,5 ± 5,3 m. When simultaneous operations the figure was 73,5 ± 13,7 minutes. There were no intraoperative complications. The mean time of hospital stay was 4,1 ± 1,3 bed-days. After surgery, patients have 7-8 hours back to normal pre-operative activities. The need for daily dressings, surgeon visits was not. The average number of visits to the surgeon on an outpatient basis was 5,2 ± 1,3 times. Relapse during the observation was not for 1 year. The patients had no complaints, physical activity does not cause discomfort, strain in the anterior abdominal wall was not, rectus abdominis edges abut one another. Conclusion. our first experience with laparoscopic elimination of diastasis recti showed that it is a highly effective method of treatment less traumatic and has a number of health and social benefits.
Keywords: diastasis of rectal muscle of abdomen, laparoscopic liquidation, endo-needle.
Today surgery lets discuss about the selection methods of mini-invasive interventions in different areas of the abdomen. Aging and constant physical activity leads to disruption ofthe anterior abdominal wall soft tissue blood circulation that stimulates the development of discrepancies musculo-fascial layer of the stomach. Thus, the rectus abdominis is one ofthe more yields in a given situation, the differences which called diastase. Among the strains of soft tissue of the anterior abdominal wall diastasis recti is 40%. The combination of diastasis recti with umbilical hernia reaches 60%, which is often ignored by surgeons during surgery, thus, recurrence of hernia. The recurrence rate in the late postoperative period ranging from 45 to 80% [1; 2; 3; 5].
More than 35 surgical methods of elimination and their modifications proposed for the treatment of diastasis. Despite this variety of correction methods, the question of choosing the most effective among them remains controversial [1; 4; 6]. It is well known that the traditional methods of surgical correction, such as plastic or Shampi-noneru by Voznesensky to eliminate diastasis of the rectus muscles of the anterior abdominal wall to the far more often used. The frequency of relapses and the development of postoperative ventral hernias up to 11.3% [2; 4].
The introduction of new technologies in surgery allowed to perform different minimally invasive surgical procedures in the
Improvements to the selection of minimally invasive techniques in laparoscopic elimination diastasis rectal muscle of abdomen
abdominal surgery with minimal traumatization of the tissues of the anterior abdominal wall. In this regard, for further improvement of existing methods, it would be advisable to study the possibility of elimination of diastasis recti mininvazivnym method.
The aim of our study is to assess the feasibility of laparoscopic elimination of diastasis recti and improve the results of treatment of such patients.
Materials and methods.
In 2 clinical TMA for the period from 2015 to 2016 performed 21 laparoscopic operations for diastasis recti II-III degree. Patients with diastase II degree was 9 (42.8%), with III — 12 (57.2%). The age of patients ranged from 36 to 62 years. 58% of patients were older than 50 years. Men were 7 women — 14 patients. In 7 patients had a concomitant pathology requires simultaneous operations: 4 — cholelithiasis, 3 — inguinal hernia.
Given the significant risk of postoperative complications in open plastic in patients with high anesthetic risk, its implementation has been limited. In such cases it is advisable to exercise clinical liquidation diastasis of the rectus muscles of the abdomen by laparoscopy
Thus, patients with IBS have 2 (9.5%), degree of obesity 2.3-2 (9.5%), diabetes — 1 (4.7%), chronic disorders of the respiratory system — 1 (4,7%). In 4 (19%) cases of simultaneous laparoscopic cholecystectomy in 3 (14.2%) — laparoscopic hernia repair. When comorbidity abdominal diastasis liquidation made the second stage, ie After performing cholecystectomy and laparoscopic hernia repair.
Results:
Laparoscopic elimination of diastasis sheathe made under anesthesia. When laparoscopy determined the boundaries of diastasis recti. The operation was carried out with the help of endoscope developed by us, "the hook-needle".
On the right (or left) edge of the medial rectus muscles, under the control of the laparoscope, through incisions of up to 2 mm input tools "endoscopic needle — hook" into the abdominal cavity and delivered thread that was fixed in the abdominal cavity endoscopic clip inserted through the working puncture. Endoscopic needle hook taken out of the abdominal cavity.
Through an existing incision in the skin at an angle of approximately 40-60 degrees endoscopic needle hook injected into the thickness of the anterior abdominal wall towards the left (or right) edge of the medial rectus muscles and entered into the abdominal cavity. The thread is fixed in endoscopic needle-hook and exteriorized. Produces extracorporeal knot tying to tension. Tie a thread of the left inside the skin, ie, at the wound site in the subcutaneous tunnel formed (Fig. 1).
Mean operative time was 52,5 ± 5,3 m. When simultaneous operations the figure was 73,5 ± 13,7 minutes. There were no intraoperative complications.
Patients intensified by the next day after surgery. Mild discomfort in the area of operational activities was observed in 5 (23.8%) patients who went through 3-4 days after surgery. In 1 (4.7%) patients had development of seroma, neuralgic pains were observed in 6 (28.5%) patients, which resolved conservatively. Other complications were noted.
Figure 1. Intraoperative and the general appearance of the patient with laparoscopic elimination of diastasis recti
The mean time of hospital stay was 4,1 ± 1,3 bed-days. After surgery, patients have 7-8 hours back to normal pre-operative activities. The need for daily dressings, surgeon visits was not. The average number of visits to the surgeon on an outpatient basis was 5,2 ± 1,3 times. Relapse during the observation was not for 1 year. The patients had no complaints, physical activity does not cause discomfort, strain in the anterior abdominal wall was not, rectus abdominis edges abut one another.
In addition to the clinical data essential criterion for assessing the outcome of the operation is the degree of reduction of the anatomical structures of the anterior abdominal wall, in particular, the linea alba and rectus muscles return to their anatomical position, which subsequently affects the improvement in the recovery of its function.
Our clinical results show that patients with grade II and III diastasis expedient surgical treatment. At the same time, we believe that laparoscopic surgery is the elimination of the selection, which allows you to save the morphofunctional state of musculo-aponeu-rotic layer of the anterior abdominal wall.
Conclusion:
Thus, our first experience with laparoscopic elimination of diastasis recti showed that it is a highly effective method of treatment less traumatic and has a number of health and social benefits: cosmetic effect; maximum comfort for the patient in the postoperative period; the absence of chronic pain that arises after the traditional elimination diastasis; low probability of adhesions in the abdominal cavity; the possibility of simultaneous performing laparoscopic surgery in comorbidity when possible to perform surgery endoscopically.
References:
1. Topchiev MA The method of surgical treatment of diastasis recti.//Surgery - 2012 - No 7. - S. 49-51.
2. Korenkov M., Beckers A., Koebke J., Lefering R., Tiling T., Troidl H. Biomechanical and morphological types of the linea alba and its possible role in the pathogenesis of midline incisional hernia.//Eur. J. Surg. - 2014. - Vol. 167, - No 12. - P. 909-914.
3. Nahas F. X., Augusto S. M., Ghelfond C. Should diastasis recti be corrected?//Aesthetic. Plast. Surg. - 2014. - Vol. 21, - No 4. - P. 285-289.
4. The abdominal lineaalba an anatomoradiologic and biomechanical study/Rath A. M., Attali P., Dumas J. L. at all//Surg. Radiol. Anat. -2013. - Vol. 18, - No 4. - P. 281-288.
5. Sanjay P., Reid T. D., Davies E. L. Retrospective comparison of mesh and sutured repair for adult umbilical hernias.//J. Hernia, - 2015, -Vol. 9, - No 3, - P. 248.
6. Spitznagle T. M., Leong F. C., Van Dillen L. R. Prevalence of diastasis recti abdominis in aurogynecological patient population.//Int. Urogynecology J. Pelvic Floor Dysfunct. - 2014. - Vol. 18, - No 3. - P. 312-318.
DOI: http://dx.doi.org/10.20534/ESR-16-11.12-90-92
Ermatov Nizom Jumakulovich, Tashkent medical academy, Hygiene of the children, teenagers and nutrition Tashkent medical academy Doctor of medical sciences Toshmatova Guzal Adilhоdjaevna Assistant of the department E-mail: evovision@bk.ru
Prevalence of mastopathies among women of Tashkent City
Abstract: On average, % women appealing to the clinic with benign breast diseases havemastopathies which has a tendency to progress in the last five years. Out of the total incidence of women with mastopathy has a leading place in: diseases of the genitourinary system, endocrine disorders of nutritional and metabolic systems, diseases of the digestive organs, blood and blood-forming organs, respiratory organs.
Keywords: mastopathy, the overall incidence of women with mastopathy, disease structure.
Mastopathy is the most common benign breast pathology. Currently mastopathy affects about 20% of women over 20 years of age and 40% of women older than 40 years. Mastopathy often develops on the background of chronic inflammatory processes in the genital organs, dysfunction of the ovaries, thyroid disorders, functional disorders of the nervous system [1; 2; 6], so treatment and prevention efforts must begin with eliminating the causative factor.
Objective: aim of the research is to assess the prevalence of mastopathies and assessment of the overall morbidity of women suffering from mastopathy.
Research materials and methods: Negotiability of women about breast pathology and the prevalence of mastitis in the dynamics in the last five years (2011-2015 years) were studied leaning on statistical records of the city Oncology Center in Tashkent. To assess the overall morbidity of women with mastopathy analyzed
Table 1. - Appeals of women about pathologies of
the results of medical examinations made in the medical records of women. In order to identify suspected risk factors for mastitis conducted a survey of women. Taken results processed by the method of variation statistics.
Research results and discussion: Results of the study negotiability of women in the city Oncology Center about breast pathology indicate that appealing of women to oncology clinic isincreasing annually (Table 1). But here negotiability of women about benign breast pathologies does notchange in dynamics, but the appealing about mastitis, especially fibrocystic tends to rise.
We drew attention to the negotiability of women for breast cancer. This rate ranged from 3.8 to 4.8% of all those who applied to the city Oncology Center. The survey interviews of these women showed that 67.1% of them had suffered a mastopathy.
breast in the city oncology center (2011-2015 years)
Appealability and its reasons Study year
2011 2012 2013 2014 2015
Overall appeals abc. 9190 9754 10650 11781 13191
- primary% 78,4 63,4 67,7 56,9 62,2
- iterative% 21,6 36,4 32,3 43,1 37,8
About benign diseases of breast pathologies in percentage from general number of appeals 58,6 60,2 58,0 58,0 58,4
- out of them about mastopathies% 60,6 63,9 64,8 76,4 88,0
- fibrous-cyctousma stopathies 26,8 28,0 32,4 32,5 37,9
Next, we studied casualties of mastopathy of women, depending on age. In most cases the disease (27.18%) was observed at 40-49 ages. Next place ranking occupied the age of 30-39 years
(23.9%), the lowest proportion of mastitis was recorded at the age of 60 years and older (14.12%).
