Primary bariatric operation as preoperative preparation stage for patients with incisional hernia with concomitant morbid obesity

Authors

  • Олександр Юрійович Усенко State Institute «National Shalimovinstitute of Surgery Andtransplantation» To Academy of Medical Sciences of Ukraine 30 Geroyev Sevastopolya str., Kyiv, Ukraine, 03680, Ukraine
  • Андрій Семенович Лаврик State Institute «National Shalimovinstitute of Surgery Andtransplantation» To Academy of Medical Sciences of Ukraine 30 Geroyev Sevastopolya str., Kyiv, Ukraine, 03680, Ukraine
  • Олександр Степанович Тивончук State Institute«National Shalimovinstitute of Surgery Andtransplantation» To Academy of Medical Sciences of Ukraine 30 Geroyev Sevastopolya str., Kyiv, Ukraine, 03680, Ukraine
  • Борис Миколайович Кондратенко State Institute «National Shalimovinstitute of Surgery Andtransplantation» To Academy of Medical Sciences of Ukraine 30 Geroyev Sevastopolya str., Kyiv, Ukraine, 03680, Ukraine

DOI:

https://doi.org/10.15587/2313-8416.2015.53975

Keywords:

phased tactics, morbid obesity, bariatric operation, postponed hernioplasty, loss of body mass, hernia relapse

Abstract

Obesity is considered as the main risk factor of incisional hernia especially in patients with morbid obesity. Among factors of relapse risk are the next ones: considerable intra-abdominal hypertension, big number of wound complications, technical (intraoperative) difficulties of hernioplasty caused by obesity. Conservative treatment of the morbid obesity has no effect.

Methods: There was carried out an analysis of treatment of patients with incisional hernia with concomitant morbid obesity (MO). They underwent bariatric operation before hernioplasty which was postponed till decrease and stabilization of body mass. Immediate and remote results were analyzed.

Results: 3o patients who underwent bariatric operation (BO) before hernioplasty took part in the research. Body mass index (BMI) was

 ≥40 kg/m2 (25 women, their mean BMI was 48,5±8,7 kg/m², intra-abdominal pressure (IAP) was 2,36±0,09 kPa. 19(63,3%) of patients underwent bending of stomach (BS), 11 (36,7 %) – shunting of stomach (SS). Three patients had complications: two seromas and pneumonia. The relapse of hernia was noticed in one patient (3,3 %). The mean loss of weight in 2 years after BS was 34,8±6,7 kg, after SS – 57,3±3,7 kg, intra-abdominal pressure – 1,31±0,08 kPa. The general number of preoperative concomitant diseases was 73. After two-year observation respiratory and metabolic disorders were completely compensated in 50 % of patients and considerably improved in 38 %.

Conclusions: The use of phased tactics of treatment leads to the most favorable results. BO gives a possibility to improve the physical state of patient and prepare him for herniaplasty

Author Biographies

Олександр Юрійович Усенко, State Institute «National Shalimovinstitute of Surgery Andtransplantation» To Academy of Medical Sciences of Ukraine 30 Geroyev Sevastopolya str., Kyiv, Ukraine, 03680

Doctor of medical sciences, professor

Scientific Director otdelah surgery gastrointestinal tract

Андрій Семенович Лаврик, State Institute «National Shalimovinstitute of Surgery Andtransplantation» To Academy of Medical Sciences of Ukraine 30 Geroyev Sevastopolya str., Kyiv, Ukraine, 03680

Doctor of medical sciences, professor

Chief Scientific department surgery gastrointestinal tract

Олександр Степанович Тивончук, State Institute«National Shalimovinstitute of Surgery Andtransplantation» To Academy of Medical Sciences of Ukraine 30 Geroyev Sevastopolya str., Kyiv, Ukraine, 03680

Doctor of medical sciences

Chief Scientific department surgery gastrointestinal tract

Борис Миколайович Кондратенко, State Institute «National Shalimovinstitute of Surgery Andtransplantation» To Academy of Medical Sciences of Ukraine 30 Geroyev Sevastopolya str., Kyiv, Ukraine, 03680

Doctor – surgeon

The scientific department of surgery of the gastrointestinal tract

References

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Lavrik, A. S., Tyvonchuk, A. S., Lavrik, A. A. (2013). Surgical treatment of obesity. Ukraine Zdorov’ja, 1, 10–11.

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Newcomb, W. L., Polhill, J. L., Chen, A. Y., Kuwada, T. S., Gersin, K. S., Getz, S. B. et. al (2008). Staged hernia repair preceded by gastric bypass for the treatment of morbidly obese patients with complex ventral hernias. Hernia, 12 (5), 465–469. doi: 10.1007/s10029-008-0381-1

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1. Yashkov, Y. I., Syneokaya,M. S.(2009). Surgical treatment of obesity and metabolic disorders. Materials Fifth Russian symposium with international participation, 90.

2. Lavrik, A. S., Tyvonchuk, A. S., Lavrik,A. A.(2013). Surgical treatment of obesity. Ukraine Zdorov’ja, 1, 10–11.

3. Rao, R. S., Gentileschi, P., Kini, S. U. (2011). Management of ventral hernias in bariatric surgery. Surgery for Obesity and Related Diseases, 7(1), 110–116. doi:10.1016/j.soard.2010.09.021

4. Tsereteli, Z., Pryor, B. A., Heniford, B. T., Park, A., Voeller, G., Ramshaw, B. J. (2007). Laparoscopic ventral hernia repair (LVHR) in morbidly obese patients. Hernia, 12(3), 233–238. doi:10.1007/s10029-007-0310-8

5. Newcomb, W. L., Polhill, J. L., Chen, A. Y., Kuwada, T. S., Gersin, K. S., Getz, S. B.et. al (2008). Staged hernia repair preceded by gastric bypass for the treatment of morbidly obese patients with complex ventral hernias. Hernia, 12(5), 465–469. doi:10.1007/s10029-008-0381-1

6. Autlo,K. M., Janin,O. L., Kruchinin,Je. V., Ivanov,V. V. (2009). Treatment of giant hernias of the anterior abdominal wall in patients with morbid obesity. Materials Fifth Russian symposium with international participation, 20.

7. Galimov, O. V., Khans, V. A., Shkundyn, A. V., Zyanhyrov, R. A., Muhametov, A. P., Mazytov, A. F. (2010). Education posleoperatsyonnoy hernia in the background of patients to obesity. Clinical Surgery, 8 (809), 8.

8. Milica, M., Toropov, Y. D., Milica, K. M. (2009). Hernia disease: a new look at pathogenesis. Clinical Surgery, 1, 35–37.

9. Newman, M. (2011). The Hole in the Wall. Bariatric Times, 8 (4), 16–17.

10. Breuing, K., Butler, C. E., Ferzoco, S., Franz, M., Hultman, C. S., Kilbridge, J. F. et. al (2010). Incisional ventral hernias: Review of the literature and recommendations regarding the grading and technique of repair. Surgery, 148(3), 544–558. doi:10.1016/j.surg.2010.01.008

11. Novitsky, Y. W. (2006). Laparoscopic Ventral Hernia Repair in Obese Patients. Archives of Surgery, 141(1), 57. doi:10.1001/archsurg.141.1.57

Published

2015-11-27

Issue

Section

Medical