Volume 03 Issue 05-2023
40
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
05
P
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:
40-45
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FACTOR
(2021:
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OCLC
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1121105677
Publisher:
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ABSTRACT
Relevance.
The analysis of scientific, medical and patent documentation indicates that in the literature available to us
there is no definition of indications for the use of one or another method of hernioplasty, taking into account various
risk factors. The solution of these problems is an urgent and priority problem of modern herniology.
Objective of the study:
To develop a program for the choice of surgical tactics for ventral hernias.
Research material.
Based on the analysis of the results of surgical treatment of 228 patients with ventral abdominal
hernias, the authors developed a program for scoring preoperative criteria that affect the choice of the optimal
method of hernioplasty, taking into account the individual characteristics of the organism.
Research results.
In the main group of patients, we detected a relapse of the disease in one patient, which was 0.9%
of the total number of patients examined in the long-term postoperative period. Relapse was noted in a patient from
the 2nd subgroup who underwent hernioalloplasty with defect suturing. The relapse was caused by the insufficient
area of the alloprosthesis.
Research Article
DIFFERENTIATED APPROACH IN VENTRAL HERNIA SURGERY
Submission Date:
May 14, 2023,
Accepted Date:
May 19, 2023,
Published Date:
May 24, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue05-07
Kurbaniyazov Zafar Babadjanovich
Samarkand State Medical Institute, Department Of Surgical Diseases No. 1, Uzbekistan
Sayinaev Farrukh Karamatovich
Samarkand State Medical Institute, Department Of Surgical Diseases No. 1, Uzbekistan
Davlatov Salim Sulaymonovich
Bukhara State Medical Institute, Faculty And Hospital Surgery, Uzbekistan
Yuldashev Parda Arzikulovich
Samarkand State Medical Institute, Department Of Surgical Diseases No. 1, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 05-2023
41
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
03
ISSUE
05
P
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:
40-45
SJIF
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FACTOR
(2021:
5.
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(2022:
5.
893
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(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
Findings.
The scoring of perioperative risk criteria in patients with incisional ventral hernias allows choosing the
optimal method of plastic surgery, taking into account the individual characteristics of the organism and improving
the results of treatment. With pronounced apron-like deformity of the abdomen in obese patients, it is preferable to
perform open hernioalloplasty with DLE.
KEYWORDS
Hernioalloplasty, scoring, program.
INTRODUCTION
Despite the dynamic development of medical science,
the problem of treating ventral hernia remains
relevant. The increase in the incidence of ventral
hernia persists mainly due to postoperative ventral
hernias, their number after laparotomy is from 10 to 15%
according to various data [5, 7].
An analysis of scientific, medical and patent
documentation indicates that in the literature available
to us there are no definitions of indications for the use
of one or another method of hernioplasty, taking into
account various risk factors. The solution of these
problems is an urgent and priority problem of modern
herniology.
Purpose of the study: To develop a program for
choosing surgical tactics for ventral hernias.
Materials and methods. The work is based on the
analysis of the results of hernioplasty in 228 patients
with postoperative, recurrent and primary ventral
hernias. All operations were performed in the surgical
department of the 1st clinic of SamMI in the period
from 2011 to 2020. The patients were divided into two
groups: the control group (96 - 42.1%) and the main
group (132 - 57.9%). Patients of the main group were
divided into 3 subgroups.
Patients of the 1st subgroup with a total score of
up to 5 (Table 1) underwent laparoscopic hernia
alloplasty. This group consisted of patients with
normal div weight, who, as a rule, had small defects
and there were no pronounced changes in the tissues
of the anterior abdominal wall, there were no
concomitant diseases and without a pronounced
adhesive process of the abdominal cavity. After
examining the abdominal cavity, such patients
underwent adhesiolysis and the hernial orifice was
isolated. Next, a U-shaped dissection and separation
of the parietal peritoneum was performed, after which
a polypropylene implant was installed in the
preperitoneal space. The mesh implant was sutured
with an Endoclose needle (Covidien, USA) to the
Volume 03 Issue 05-2023
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International Journal of Medical Sciences And Clinical Research
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Publisher:
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Servi
anterior abdominal wall from the inside with knots tied
over the aponeurosis. Then, with a continuous suture
over the mesh, the integrity of the peritoneum was
restored.
The 2nd subgroup included patients with normal
or overweight and functional disorders of the
respiratory system, concomitant somatic pathology
and severe adhesive disease of the abdominal cavity.
They had from 6 to 10 points and, taking into account
the risk of perioperative complications, they
underwent open hernioplasty in 2 ways: the defect of
the aponeurosis was sutured edge to edge with
additional cover of the suture line with a polypropylene
mesh; Patients with a risk of increased intra-abdominal
pressure underwent tension-free hernioplasty without
suturing the aponeurosis. This made it possible to
avoid an increase in intra-abdominal pressure in the
early postoperative period.
Table 1.
Point system of indications for the use of different methods of plastics
№
Risk factors
Quantitative characteristic
Points
1
The state of the abdominal wall
according to ultrasound, CT.
Norm
Mild weakness
Severe weakness
0
1
2
2
Dimensions of the hernia gate
Up to 5 sm
6-10 sm
11-15 sm
More than 15 sm
0
1
2
3
3
Weight (div mass index)
Norm
Obesity I-II degree
Obesity III-IV degree
0
1
2
4
Age
25-44 year
45-59 year
60-74 year
75-90 year
0
1
2
3
5
Duration of hernia
up to 1 year
from 1 year to 3 years
over 3 years
0
1
2
6
Exercise stress
Absent
Moderate load
heavy load
0
1
2
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Publisher:
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7
The functional state of the
respiratory system
No violations
Intermittent difficulty breathing
Chronic respiratory failure
0
1
2
8
Concomitant
other
somatic
diseases
No
available in mild form
available in severe form
0
1
2
9
Concomitant diseases leading to
increased intra-abdominal pressure
No
available in mild form
available in severe form
0
1
2
10
The severity of the adhesive
process
No adhesive process
Adhesions between the hernial sac
Abdominal adhesions
0
1
2
In the 3rd subgroup of patients with scores from 11 to
20, who had grade III obesity, as well as large (W3) and
giant (W4) hernias according to Chervel J.P. and Rath
A.M. (1999) also used open hernioplasty in 2 ways, as
was done in patients of the 2nd subgroup, but in this
subgroup,
in
addition
to
hernioplasty,
dermatolipidectomy (DLE) was performed.
To compare the results obtained, we took as a control
group 96 patients who were operated on for ventral
hernias in a planned manner without taking into
account the scoring. The same plasty methods were
used as in the main group.
RESULTS AND ITS DISCUSSION
Long-term
results
of
surgical
treatment
of
postoperative and recurrent hernias of the anterior
abdominal wall were monitored by us in 196 patients in
the range from 1 to 10 years. Of the 196 patients
examined with long-term outcomes studied, 112 were
from the main scoring groups and 84 were from the
control group. Of the 84 examined patients in the
control group, plastic surgery using local tissues was
performed in 36 patients, plastic surgery using a
polypropylene mesh - 41, and tension-free plastic
alloplasty - in 7 patients. Of the 112 examined patients
who underwent plastic surgery taking into account the
score, laparoscopic hernia alloplasty was performed in
31, open hernioplasty with defect suturing - 6, tension-
free alloplasty - 26, open hernia alloplasty with defect
suturing and DLE - 12, tension-free alloplasty and DLE -
37.
In the main group of patients, we detected a relapse of
the disease in one patient, which amounted to 0.9% of
the total number of patients examined in the late
Volume 03 Issue 05-2023
44
International Journal of Medical Sciences And Clinical Research
(ISSN
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VOLUME
03
ISSUE
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P
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SJIF
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FACTOR
(2021:
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(2022:
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893
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(2023:
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OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
postoperative period. A relapse was noted in a patient
from the 2nd subgroup, who underwent hernioplasty
with suturing of the defect. The reason for the
recurrence was the insufficient area of the
alloprosthesis.
In the group in which plastic surgery of the anterior
abdominal wall was performed without taking into
account the scoring, recurrence of the disease was
detected in 7 (8.3%) patients out of 84 examined in the
late postoperative period. Moreover, the recurrence
was in 5 patients with III degree obesity and in 2
patients with large hernias (W3). At the same time, 3
patients with III degree obesity underwent
hernioplasty using the laparoscopic method. When
studying the causes of recurrence at the macro- and
microscopic levels, we found that under the influence
of the gravitational force of the skin-fat apron, the
mesh prosthesis installed preperitoneally shifts
downward, thereby exposing a weak spot in the
abdominal wall, where the upper part of the prosthesis
was fixed. 4 patients with grade III obesity and large
hernias (W3) underwent edge-to-edge plasty with
additional reinforcement of the suture line with a
polypropylene mesh. The cause of recurrence in 2
patients was also the downward displacement of the
previously applied prosthesis due to the effect of the
gravitational force of the skin-fat apron. In patients
who underwent DLE, no relapses were detected. In 2
more patients, the displacement of the prosthesis was
facilitated by a more pronounced exudative reaction
and, accordingly, a slower fibrous incorporation of the
prosthesis.
CONCLUSIONS
Thus, the scoring of perioperative risk criteria in
patients with incisional ventral hernias makes it
possible to choose the optimal plasty method taking
into account the individual characteristics of the div
and improve treatment results. The cause of relapses
in ventral hernia alloplasty in obese patients is the
displacement of the prosthesis downwards under the
influence of the severity of the skin-fat apron. In
severe apron-like deformation of the abdomen in
patients with obesity, it is preferable to perform open
hernioplasty with DLE.
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Volume 03 Issue 05-2023
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International Journal of Medical Sciences And Clinical Research
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VOLUME
03
ISSUE
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:
40-45
SJIF
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FACTOR
(2021:
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(2022:
5.
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1121105677
Publisher:
Oscar Publishing Services
Servi
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