Retrospective analysis of the results of surgical treatment of patients with primary ventral hernias associated with diastasis of the rectus abdominal muscles under the conditions of the metabolic syndrome
DOI:
https://doi.org/10.11603/2414-4533.2023.3.14156Keywords:
primary ventral hernia, diastasis of rectus abdominis muscles, metabolic syndrome, complicationsAbstract
The aim of the work: to conduct a retrospective analysis of the results of surgical treatment of patients with ventral hernia in combination with diastasis of the rectus abdominis muscles with the determination of the main risk factors for the occurrence of complications in patients with metabolic syndrome.
Materials and Methods. The results of surgical treatment of 183 patients operated on for primary ventral hernia with accompanying metabolic syndrome in 2018–2022 were analyzed. 141 women and 42 men were operated on. The age of the patients ranged from 18 to 84 years (average age – (53.4±5.6) years). The duration of the hernia was from 2 to 34 years. 45 patients were operated on with primary ventral hernias. The remaining 138 patients were operated on with primary ventral hernias combined with diastasis of rectus abdominis muscles. Degree I of diastasis of rectus abdominis muscles was observed in 9 (50.00 %), degree II in 5 (27.78 %) and degree III in 4 (22.22 %) patients. Among the primary ventral hernias, M1 defects were found in 5, M1-3 in 31, and M3 in 9 operated patients. In patients with a primary ventral hernia in combination with diastasis of rectus abdominis muscles, the following localization and spread of anterior abdominal wall defects were diagnosed: M1-93, M1-3 – 23, and variant M1-5 in this group in 4 people. Among patients with a primary ventral hernia, a predominance of size W1-2 -31 was diagnosed, and in patients with a primary ventral hernia combined with diastasis of rectus abdominis muscles, according to the size of the defect of the anterior abdominal wall, a significantly larger number of patients with large hernias W3 and > - 71. The evaluation of the obtained data was carried out by comparing early and remote complications after various types of surgical interventions.
Results and Discussion. Among the common complications in the early postoperative period, pulmonary embolism was observed 1 (0.5 %), abdominal compartment syndrome 4 (2.19 %), and as a consequence of the transferred abdominal compartment syndrome, postoperative pneumonia 4 (2.19 %). The highest proportion of recurrences was observed when performing native tissue hernioplasty 11 (31.43 %) and allohernioplasty by onlay type 4 (16.0 %), and the lowest number of recurrences was observed when performing laparoscopic hernioplasty 3 (9.68 %) and by the E-Milos method (0%). Among the wound complications, seromas, hematomas, and suppuration of postoperative wounds prevailed during tissue hernioplasty, onlay, and hernioplasty in combination with dermatolipectomy.
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