The detection of concomitant surgical diseases of the abdominal organs during the examination of the patient or during laparotomy raises the question of the necessity and possibility of its elimination by performing a simultaneous operation. If we take into account that in recent years 20-30% of patients admitted to surgical hospitals have been diagnosed with combined diseases of the abdominal organs requiring surgical correction, then the urgency of the problem is beyond doubt.
The improvement of surgical techniques, the successes of anesthesiology allow [to expand the indications for performing simultaneous operations in abdominal surgery.
Simultaneous surgical correction of several diseases is in many ways preferable to multi-stage treatment, since it relieves the patient from two or more diseases, from the need for repeated surgery and possible postoperative complications associated with it.
Simultaneous operations also have certain economic advantages due to a reduction in the duration of the patient's stay in a medical institution and temporary disability in comparison with multi-stage surgical treatment.
The aim of the study to improve the results of surgical treatment of patients with ventral hernias and concomitant abdominal pathology by optimizing the tactical and technical aspects of the simultaneous performance of simultaneous operations with the priority use of endovideosurgical technologies and tension-free plasty methods.
The object of the study were 331 patients with ventral hernias and concomitant simultaneous pathology of the abdominal organs, who were hospitalized in the surgical departments of the clinic of the Samarkand State Medical University for a period from 2012 to 2021.
The scientific novelty of the research is as follows: laparoscopic technologies were applied at certain stages of surgical intervention, which justified itself, since at the same time it allows to eliminate the hernia of the abdominal wall and the simultaneous pathology of the abdominal organs and correct it in a minimally invasive way; it was found that more than ½ (52.8%) of patients with ventral hernias have concomitant abdominal pathology that requires a one-time surgical correction, since the performance in a subsequent repeated operation levels out the results of hernioplasty; justified the use of laparoscopic technologies at certain stages of the operation, which allows correcting the simultaneous pathology of the abdominal cavity in a minimally invasive way with a significant removal of it from the hernial defect of the abdominal wall; the effectiveness of endovideosurgical technology for performing alloplasty in W1 and W2 hernias has been proven; the high information content of CT-hernioabdominometry has been proven, which makes it possible to identify defects in the topography of the anterior abdominal wall before surgery, determine the relative volume of the hernia to the volume of the abdominal cavity and choose the optimal method of hernioalloplasty; improved technical and tactical aspects of non-tension methods of hernioplasty for ventral hernias W3 and W4; the study of the dynamics of stress hormones proved that the implementation of the simultaneous stage of the operation does not significantly affect the degree of surgical aggression and thus justifies the expediency of a one-time correction of the combined pathology of the anterior abdominal wall and abdominal organs; optimization of tactical and technical aspects of one-time surgical correction of ventral hernia and combined abdominal pathology with the priority use of endovideosurgical technologies and tension-free alloplasty methods significantly improved the results of treatment.
The practical results of the study are as follows: According to the results of a scientific study to improve the diagnosis and surgical treatment of patients with ventral hernias and concomitant abdominal pathology: a methodological recommendation “Surgery of abdominal hernias and combined pathology of the anterior abdominal wall” was developed (certificate of the Ministry of Health 8н-р / 1080 dated October 7, 2022); a methodological recommendation "Surgical correction of combined abdominal pathology in ventral hernias" was developed (certificate of the Ministry of Health 8н-р / 1086 dated October 7, 2022). The proposed recommendations made it possible to optimize the choice of tactics for surgical treatment of patients with ventral hernias and concomitant surgical diseases of the abdominal organs; the obtained scientific results on improving the quality of diagnosis and surgical treatment of patients with ventral hernias and simultaneous surgical diseases of the abdominal organs have been introduced into the practice of healthcare, in particular, in the departments of surgery of the Samarkand city medical association, the Samarkand regional multidisciplinary medical center, the multidisciplinary clinic of Samara State Medical University, Shakhrisabz city medical association, Surkhandarya regional diversified medical center, Jizzakh regional diversified medical center (certificate of the Ministry of Health 8н-д / 570 dated October 24, 2022). The introduction of the results of research on improving the tactical and technical aspects of the surgical treatment of patients with ventral hernias and simultaneous surgical diseases of the abdominal organs substantiated the possibility of simultaneous performance of simultaneous operations in the combined pathology of the abdominal organs and the anterior abdominal wall, avoiding repeated operations after hernia alloplasty.
The structure and scope of the dissertation. The dissertation consists of an introduction, seven chapters, a conclusion, and a list of references. The volume of the main material is 153 pages.
The monograph presents the main theoretical issues concerning ventral hernias and combined pathology of abdominal organs. The etiology, pathogenesis, clinic, diagnosis, treatment and methods of prevention in a large contingent of patients with ventral hernias and combined pathology of abdominal organs are covered in detail. The methods of preoperative preparation developed by the authors, comparative assessment of the level of stress hormones, technical aspects of surgical interventions in patients with ventral hernias and combined pathology of abdominal organs are highlighted. The analysis of the quality of life of patients was also carried out according to an improved score assessment of the quality of life of patients after simultaneous operations.
The monograph is intended for surgeons, clinical residents and students of medical institutes.