International Journal of Biomedicine. 2019;9(3):237-241.
Originally published September 15, 2019
The aim of the study was to assess surgical treatment outcomes of patients with large and giant postoperative reducible medial abdominal hernias based on the developed algorithm for selecting the optimal method of hernioplasty.
Materials and Methods: The study included 31 patients with large and giant postoperative reducible medial abdominal hernias. Before and after the operation, all patients underwent an electromyographic assessment of the functional state of the anterior abdominal wall muscles with determination of the muscle fatigue index (FI). FI≤2.4 indicated the preserved muscle function. In addition, on patients of the experimental group we performed a simulation of the postoperative situation with determination of the intra-abdominal pressure (IAP) level by measuring blood oxygen saturation (SpO2). A specific method of plastic surgery was chosen based on the obtained parameters of the increase in FI and IAP levels (a decrease in SpO2). The adequacy of the surgical treatment option was supported by monitoring the SpO2 level in the early postoperative period (Days 1, 3, and 7). Absence of a significant increase in IAP and adequate reduction in the SpO2 level indicated the proper choice of plastic technique.
Results: In the patients of the experimental group, who were operated on with reconstructive plastic surgery, the average parameters of FI of the abdominal wall muscles were within 1.89|1.68|2.0 (P<0.05), which is evidence for the preservation of muscle function and an adequate choice of the surgical treatment option. In patients of the comparison group, who had been operated on with corrective methods of surgical treatment, the parameters of FI were within 2.79|2.52|3.16 (P<0.01), which is evidence for the loss of muscle function of the anterior abdominal wall.
Conclusion: The proposed algorithm for choosing a method of hernioplasty based on the width of the hernia orifice and preoperative assessment of additional parameters, such as the functional state of the anterior abdominal wall muscles and the level of SpO2, in simulation of the postoperative situation allowed for a differentiated, functionally oriented approach toward the choice of surgical treatment options in patients with large and giant postoperative reducible medial abdominal hernias.
- Gogia BSh, Alyautdinov RR, Kopyltsov AA, Tokareva TV. New technologies in the treatment postoperative abdominal wall hernias. Vysokotekhnologicheskaya Meditsina. 2016;3 Available from: http://vmedin.ru/articles/26-2016-04-07-09-07-09/2016/1-2/70-2016-12-21-... [Article in Russian].
- Polubkova GV, Cherednikov EF, Kashurnikova MA. Physical rehabilitation of patients after laparoscopic hernioplasty for inguinal hernias. Proceedings of the V All-Russian Distant Scientific and Practical Conference with international participation “Biomedical and pedagogical bases of adaptation, sports activities and a healthy lifestyle”. Voronezh; 2016:288-291. [Article in Russian].
- Polubkova GV, Cherednikov EF, Kashurnikova MA, Shlykov OA, Usov YV, Tkachev IE, et al. Evaluation of the results of laparoscopic transabdominal preperitoneal plasty in the treatment of patients with inguinal hernias. Nauchno-meditsinskiy vestnik Tsentralnogo Chernozemya. Voronezh. 2016;(65):10-13. [Article in Russian].
- Strygin OV, Polubkova GV, Mikhailova GN, Cherednikov EF, Gulyaev AA., Krasikov AI, et al. Experience of application of topographically and anatomically based, functionally-oriented methods of plasty of inguinal hernias. Nauchno-meditsinskiy vestnik Tsentralnogo Chernozemya. Voronezh. 2016;(65):14-19. [Article in Russian].
- Cherednikov EF, Polubkova GV, Glukhov AA, Skorobogatov SA. Selecting the Way to Surgical Treatment of Patients with Postoperative the Median Rectifiable Hernia Based Noninvasive Evaluation of Intra-abdominal Pressure. Journal of Experimental and Clinical Surgery. 2017;10 (2):103-110. [Article in Russian].
- Lyubykh EN, Komkova EA, Slepokurova TA. (2013). The method of selecting the type of surgical treatment of patients with hernial defects of the anterior abdominal wall. Russian Federation Patent # 2491887 (25).2013. [In Russian].
- Gelfand BR, Protsenko DN, Podachin PV. Abdominal hypertension syndrome: the state of the problem. Medical alphabet. Emergency Medicine]. 2010; 3: 34–42. [Article in Russian].
- Berger D, Lux A. [Operative therapy of secondary ventral hernia: technical principles]. Chirurg. 2013;84(11):1001–1012. doi: 10.1007/s00104-011-2245-y. [Article in German].
- Hanna EM, Byrd JF, Moskowitz M, Mann JW, Stockamp KT, Patel GN, et al. Outcomes of a prospective multi-center trial of a second-generation composite mesh for open ventral hernia repair. Hernia. 2014 Feb;18(1):81-9. doi: 10.1007/s10029-013-1078-7.
- Shestakov AL, Inakov AG, Ckhovrebov AT. Estimation of the effectiveness of hernioplasty in patients with hernias of the anterior abdominal wall using the SF-36. Bulletin of Pirogov National Medical & Surgical Center. 2017; 12 (3): 50-53. [Article in Russian].
- Belokonev VI, Vavilov AV, Gulyaev MG, Grachev DB. Tactics of treatment of patients with recurrent postoperative incisional hernias. Tavricheskiy mediko-biologicheskiy vestnik. 2018;21(2):17-23. [Article in Russian].
- Zakurdaev EI, Chernyh AV, Cherednikov EF, Zakurdaeva MP. Topographic-Anatomic Justification of Various Methods Reducing Tissue Tension at Prosthetic Incisional Hernia Repair by «Sublay». Journal of Experimental and Clinical Surgery. 2017;10(1):26-31. [Article in Russian].
- Malbrain MLNG, Jones F. Intra-abdominal pressure measurement techniques. In: Ivatury RR, Cheatham ML, Malbrain MLNG, Sugrue M, editors. Abdominal Compartment Syndrome. Landes Biomedical, Georgetown, 2006.
- Timoshin AD, Shestakov AL, Zagorulko OI., Inakov AG. Abdominal wall muscles function estimation after hernioplasty. Bulletin of Siberian Medicine. 2007;3:62. [Article in Russian].
- Cherednikov EF, Polubkova GV, Skorobogatov SA, Novikova EI. Results the application to non-invasive evaluation of intra-abdominal pressure in the surgical treatment of patients with postoperative the median free hernia. System analysis and management in biomedical systems]. 2017; 16(2):328-334. [Article in Russian].
- Skorobogatov S.A., Lyubykh E.N., Baskakov E.I. A method for assessing intra-abdominal pressure in patients with abdominal hernias. Russian Federation Patent #2575336 (5). 2016. [In Russian].
- Lyubyh EN, Polubkova GV. On some problematic issues of herniology and ways to solve them. Gerniologiya. 2009;2(22):14-17.[Article in Russian].
Received August 2, 2019.
Accepted September 2, 2019.
©2019 International Medical Research and Development Corporation.