| Abstract | Popravak velikih ventralnih hernija velik je izazov u kirurgiji. Na pojavu ventralne hernije utječu mnogi čimbenici poput tjelesne težine, prethodne laparotomije, spola, omjera kolagena tipa I i tipa III, broja trudnoća itd. Liječenje ventralnih hernija najčešće je elektivan kirurški zahvat s vrlo malo kontraindikacija za sam zahvat poput nemogućnosti podnošenja anestezije ili općeg lošeg stanja.
Iako se tegobe prouzrokovane protruzijom organa mogu ublažiti nošenjem kilnog pojasa, jedino konačno liječenje je kirurško. Početni pristup koji se sastojao od jednostavnog prešivanja defekta u fasciji dovodio je do visoke stope recidiva. Popravak velikih abdominalnih defekata ponekad je vrlo kompleksan te se nastavilo s razvijanjem protetskih materijala kao i tehnika kojima bi se defekti liječili. Prvotne mrežice koje su se koristile u popravku defekata pokazivale su visoku stopu odbacivanja kao i infekcija. Mrežice su se razvijale te su danas standard u popravku abdominalnih defekata. Na tržištu postoji više od 70 vrsta u koje ubrajamo resorptivne biološke, sintetske resorptivne i neresorptivne.
Zlatnim standardom za liječenje ventralnih hernija danas se smatra metoda Rives-Stoppa metoda. Također se koriste tehnike poput Ramireza te da Silvine tehnike.
Sve popularnije postaju minimalno invazivne metode koje se po položaju postavljanja mrežice dijele na retromuskularne, suprafascijalne te intraperitonealne. Retromuskularne metode su: MILOS, eMILOS, TAPP, MIC Rives Stapler Repair, eTEP i dr. Suprafascijalne metode popravka ventralnih hernija su: TESLA,SCOLA, ELAR. U intraperitonealne metode ubrajamo IPOM te LIRU.
Pri odabiru metode valja uzeti u obzir opće stanje pacijenta, dostupne materijale kao i iskustvo kirurga u popravku kompleksnih abdominalnih defekata. |
| Abstract (english) | Repair of ventral hernias is a big challenge in modern surgery. Ventral hernias are induced by many factors, such as body mass, history of laparotomy, gender, ratio of collagen type I and type III, number of pregnancies. Most of the time, the treatment of ventral hernias is done by an elective surgical procedure with few contraindications such as intolerance to anesthesia or a bad general condition of the patient.
The hardship which is made by the organ protrusion can be soothed by wearing a hernia belt, however, the only permanent solution is a surgical procedure. The initial approach of a simple defect quilting in the fascia was leading to a high recurrence rate. Mending of the huge stomach defects is sometimes a complex procedure so in order to develop new techniques a big number of prosthetic materials was developed. The first prosthetic meshes which were used in the mending of defects showed a big rejection rates, and the same holds true for the infection rates. Meshes have continuously been developed and are nowadays a standard repair technique for stomach defects. There are more than seventy types of medical meshes on the market including biological, synthetic resorptive and synthetic no-resorptive.
The golden standard in the treatment of ventral hernia is the Rives-Stopp method. Techniques such as Ramirez and da Silva are often used as well. However, a rise in popularity has been noted for the minimally invasive methods which are divided according to the placement of the mesh. They are classified into retro-muscular, suprafascial and intraperitoneal methods. Retro-muscular methods are: MILOS, eMILOS, TAPP, MIC Rives Stapler Repair, eTEP, etc. Suprafascial methods for the treatment of ventral hernias are: TESLA,SCOLA, ELAR. Intraperitoneal methods include IPOM and LIRA.
When choosing the surgical method it is necessary to determine the general condition of the patient, available materials (surgical meshes) and the general experience of the surgeon in the treatment of complex stomach defects. |
