Primary bariatric operation as preoperative preparation stage for patients with incisional hernia with concomitant morbid obesity
DOI:
https://doi.org/10.15587/2313-8416.2015.53975Keywords:
phased tactics, morbid obesity, bariatric operation, postponed hernioplasty, loss of body mass, hernia relapseAbstract
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
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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
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Copyright (c) 2015 Борис Миколайович Кондратенко, Олександр Юрійович Усенко, Андрій Семенович Лаврик, Олександр Степанович Тивончук
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