Application value of initiative content reduction surgery in the prevention and treatment of postoperative intra-abdominal hypertension of obese patients with giant ventral hernia

Abstract

Objective To investigate the clinical effect of initiative content reduction surgery in the herniorraphy on the prevention and treatment of postoperative intra-abdominal hypertension of obese patients with giant ventral hernia. Methods The retrospective cross-sectional study was adopted. The clinical data of 62 obese patients with giant ventral hernias who were admitted to the Chao-Yang Hospital of Capital Medical University from January 2011 to December 2015 were collected. The initiative content reduction surgery was adopted during the herniorraphy of ventral hemia. Observation indices: (1) surgery situations: operation time, length of resected intestines, volume of intraoperative blood loss. (2) Postoperative recovery situations: change between preoperative and postoperative urethral bladder pressure, organ function of heart, lung, liver and kidney, time of gastro-intestinal function recovery, time of drainage tube removal and duration of postoperative hospital stay. (3) Postoperative complications: incisional infection and intestinal fistula. (4) Follow-up situations. Follow-up using outpatient examination at 1 week, 1 month, 3 months and 6 months after surgery and using telephone interview at postoperative year 1 was conducted up to June 2016. The follow-up included hernia recurrence and chronic infection. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were represented as M (range) and analyzed by rank-sum test. Results (1) Surgery situations: all the 62 patients received successful herniorraphy of giant ventral hemia combined with initiative content reduction surgery. Operation time, length of resected intestines and volume of intraoperative blood loss were (115±22)minutes, (207±64)cm and (52±35)mL. (2) Postoperative recovery situations: the preoperative urethral bladder pressure was 18 cmH2O (range, 15-22 cmH2O, 1 cmH2O=0.098 kPa) and postoperative urethral bladder pressure was 8 cmH2O (range, 6-11 cmH2O), with a significantly statistical difference between before and after surgery (Z=-9.662, P<0.05). There was no abnormal function of heart, lung, liver and kidney after operation. The time of gastrointestinal function recovery, time of drainage tube removal and duration of postoperative hospital stay were 3.8 days (range, 3.0-6.0)days, (3.8±1.1)days and (14.5±1.9)days. (3) Postoperative complications: of 62 patients, 4 were complicated with incisional infection and improved after symptomatic treatment. There was no intestinal fistula. (4) Follow-up situations: all the 62 patients were followed up for (36±19)months. During the follow-up, 3 patients had incisional hernia recurrence and then were followed up without reoperation. No chronic infection occurred. Conclusion Initiative content reduction surgery is effective and feasible in the prevention and treatment of intraoperative intra-abdominal hypertension of obese patients with giant ventral hernia. Key words: Giant ventral hernia; Herniorraphy; Abdominal hypertension; Initiative content reduction; Obesity