Selecting the Way to Surgical Treatment of Patients with Postoperative the Median Rectifiable Hernia Based Noninvasive Evaluation of Intra-Abdominal Pressure

Abstract

Relevance. Currently, there is no single common approach to the treatment of postoperative median herniasObjectives. To develop an algorithm for choosing the method of surgical treatment of patients with postoperative median rectifiable abdominal hernias based on a noninvasive assessment of changes in intra-abdominal pressure by determining oxygen saturation.Materials and methods. The research was performed in 65 patients with postoperative median, rectifiable hernia of various sizes. All patients are divided into three main groups. We used an indirect technique for determining changes in intra-abdominal pressure by examining the saturation of blood with oxygen. Four methods of plastics were applied to patients with median postoperative hernias:1) plastic by own tissues in the form of duplicate (according to Sapezhko);2) plastic in the form of duplicate with immobilization of the wound on surgical bridges [9];3) two-stage hardware operation method, developed by Professor Lyubykh EN [9];4) prosthetics of the abdominal wall with a mesh prosthesis.Results and its discussion. In the first group of patients with small hernias, when modeling the postoperative situation (immersion of the hernial contents in the abdominal cavity with the help of a pelot, and simultaneous approach of the hernial gates with the help of a bandage), the saturation was reduced insignificantly (97,1 ± 1,5% (p <0,05), which allowed us to recommend plastic by own tissues in the form of dublication. In the second group of patients with medium-sized hernias, the saturation was moderately reduced during the simulation (95,4 ± 1,4% (p <0,05). Plastics in the form of dublication with immobilization of the wound on the surgical bridge has been recommended these patients.In the third group of patients with extensive and giant hernias, blood oxygen saturation was significantly reduced (91,5 ± 1,5% (p <0,05). Such patients with extensive and giant hernias and a and long term hernia has been recommended prosthetic abdominal wall with mesh prosthesis. If the hernia disease is less than 5 years of age and patients of working age, two-stage hardware method of treatment hernias created by professor E. N. Lyubykh has been recommended. [9]Conclusion. The proposed algorithm for choosing a method of plastic surgery for postoperative median repaired hernias based on preoperative determination of oxygen saturation with oxygen under different conditions allows for a differentiated functionally oriented approach to the treatment of patients and a reduction in the number of relapses.