THE TREATMENT OF PATIENTS WITH POSTOPERATIVE ABDOMINAL WALL HERNIA AND OBESITY

Storozhenko O. V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Experience of simultaneous operations performance in 113 patients with morbid obesity coexistent with postoperative abdominal wall hernia (POAWH) was summarized. In the planned order 108 patients were operated on and for urgent indications – 5. Deformation of the abdominal wall, which required surgical correction, detected in 106 (93,8%) patients. Using differentiated approach allowed not only to firmly close a variety of localization and size of defects, at the same time eliminate the associated diseases that require surgical treatment, avoiding reoperations and associated complications, emotional and financial burden. The approach was proposed for the choice of method and volume of operative intervention. To improve the results of surgical treatment of patients with ventral hernias and obesity a methodology based on comprehensive prevention of postoperative wound complications at all stages of the perioperative period have been proposed and used. According to the analysis of postoperative period it was managed to reduce the number of wound complications in patients. Results of abdominoplasty conduction in 206 patients were analysed. Early postoperative complications are studied and methods of their prophylaxis are elaborated. Minimization of the local complications rate was achieved due to estimation of the anterior abdominal wall state, rational combination of dermolipectomy and liposuction, prophylaxis of microcirculation disorders. In detailed analysis of remote, first of all, esthetic results of the anterior abdominal wall plasty we have concluded about necessity of the state estimation of surrounding anatomic structures. While planning and conduction of the anterior abdominal wall plasty it is mandatory to take into account the pubis subcutaneous layer width, as well as lateral regions of abdominal wall, pelvis and costal arcs, the form and localization of costal arcs, especially of ХІІ rib and a vertebralcolumn form. Such approach have secured the operation esthetic level raising, reduction of local complications rate, permitted more trustworthy to prognosticate the outcome. The appropriateness for combining dermatolipectomy and allohernioplasty with the latest polymeric material in obese patients with hernia of abdominal wall has been substantiated. The substantiated performance of simultaneous operations for POAWH in patients with morbid obesity and other diseases of abdominal cavity organs constitutes the perspective trend in surgery, secures high medical-social and economic efficacy.

postoperative abdominal wall hernia, obesity, coexistant surgical diseases, simultaneous operations, dermatolipectomy

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«Bulletin of problems biology and medicine» Issue 1 Part 1 (142), 2018 year, 182-186 pages, index UDK 617.55-089.844-089.12

10.29254/2077-4214-2018-1-1-142-182-186