Anterior Abdominal Wall Hernias Research Articles

EFFECT OF ADDITION OF DEXAMETHASONE TO ROPIVACAINE ON POST-OPERATIVE ANALGESIA IN ULTRASOUND-GUIDED TRANSVERSE ABDOMINIS PLANE BLOCK FOR ANTERIOR ABDOMINAL WALL HERNIA REPAIR

Objective: The objective of the present study was to evaluate the adjuvant effect of dexamethasone to Ropivacaine in ultrasound-guided transverse abdominal plan block for anterior abdominal wall hernia repair. Methods: A single-blind randomized control trial was conducted by selecting patients undergoing anterior abdominal wall hernia and dividing them into two groups with Group A: received a total of 50 mL of 0.2% Ropivacaine (48 mL) with normal saline (2 mL) and Group B received a total 50 mL of 0.2% Ropivacaine (48 mL) with 8 mg dexamethasone (2 mL). Outcome was assessed on the basis of visual analog scale (VAS), the requirement of rescue analgesia, and adverse events. Results: Twenty-seven patients were recruited in each group, Group A and Group B had an average pain-free interval of 11.85±2.82 and 8.07±2.51, respectively (p<0.001). Mean VAS was lower in Group B at the end of 2 h (p<0.05). Both the groups had similar side effects with no significant difference. Total analgesia dose required in Groups B and A was 75 and 96 mg, respectively (p<0.001). Conclusion: A combination of 0.2% Ropivacaine (48 mL) with 8 mg dexamethasone (2 mL) significantly reduces the VAS in post-operative pain along with reduced quantity and frequency of rescue analgesia.

Outcome of the incarcerated abdominal wall hernias managed by open and laparoscopic approaches

Background & Objective: Laparoscopic surgery is generally considered as better than open surgery in terms of less complications, minimal hospital stays and quick healing of the wounds. Our objective was to compare the immediate and early outcome of the different incarcerated hernias of anterior abdominal wall operated on as emergency cases by open and laparoscopic approach.
 Methods: This is a retrospective comparative study which was conducted at two hospitals of AlAhsa city of the Eastern region of the Kingdom of Saudi Arabia from July, 2017 to June, 2022. The data were retrieved from the medical records of the hospitals. All male and female patients having different types of incarcerated hernias of anterior abdominal wall presenting to the emergency room were included in the study. The patients were divided in two groups; those who were operated on by open approach (Group-I) and those who were operated on by laparoscopic approach (Group-II).
 Results: Out of total 70 male and female patients, 42 were in Group-I and 28 in Group-II. The variety of the incarcerated hernias in both groups overall was para-umbilical 26(37.14%), incisional 18(25.71%), inguinal (right & left) 17(24.28%) and epigastric 9(12.86%). The mean operative time taken by Group I and II was 126.07 (±9.728) and 98.57 (±10.079) minutes respectively with a difference of 27.50 minutes (p=0.807). The mean hospital stay of the patients in Group I and II was 1.36(±0.719) and 1.57(±0.997) days respectively (p=0.482). The post-operative complications rate in Group-I was 6(14.28%) and in Group-II, 6(21.43%) (p=0.658). Overall, 12(17.14%) patients developed the complications in both groups. When the number of the complications is compared, it shows that there was no significant difference between the two groups (p=0.583).
 Conclusion: Laparoscopic approach is not superior to the open approach in the terms of the immediate and early outcome/complications of the incarcerated hernias of the anterior abdominal wall operated as emergency cases in this study.
 doi: https://doi.org/10.12669/pjms.40.5.8899
 How to cite this: AlWadaani HA, Memon AQ. Outcome of the incarcerated abdominal wall hernias managed by open and laparoscopic approaches. Pak J Med Sci. 2024;40(5):---------. doi: https://doi.org/10.12669/pjms.40.5.8899
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

MORPHOLOGICAL FEATURES OF THE REPARATIVE PROCESS IN THE PLASTIC SECTION OF THE MUSCLE-APONEUROTIC DEFECT IN THE EXPERIMENT USING STEM CELLS

Abstract. Anterior abdominal wall hernia repair is one of the most common procedures in general surgery. Very often, the parameters of the quality of life of operated patients with ventral hernias of the anterior abdominal wall during the fi rst year after the operation, according to a number of criteria, are signifi cantly better with alloplastic with polypropylene mesh, in contrast to the use of hernioplasty with the use of inert suture material. Hernias of the anterior abdominal wall (ventral hernias) most often occur after surgical intervention on the organs of the abdominal cavity and are considered postoperative complications arising in anatomically weak areas and under the infl uence of mechanical factors. The goal of the work. To experimentally investigate the eff ect of mesenchymal stem cells on the regeneration of muscle fi bers and their reparative properties in the area of postoperative wounds. When modeling a muscle- aponeurotic defect of the anterior abdominal wall with plasticity with own tissues and plasticity with an allograft in combination with injections of mesenchymal stem cells. The study was conducted on 38 white rats of both sexes, the initial weight of each animal was 215±12 g, the experimental animals were kept in the same conditions with full compliance with bioethical norms. All animals of groups 1 and 2 were experimentally modeled a muscle- aponeurotic defect of the anterior abdominal wall by an acute method up to 2.5 cm in diameter, followed by layer-by-layer suturing of this defect with a continuous wraparound single-row suture, «Vicryl» 3/0 with a barb was used as suture material with a needle In the 2nd group, plastic surgery was performed using the «on lay» technique with polypropylene mesh and suture material «Vicryl» 3/0 with a barbed needle, and mesenchymal stem cell injections were additionally performed. At the plastic site of the muscle- aponeurotic defect, the tissue of the anterior abdominal wall was taken in full layers for further histological examination. Histological examination of the wound tissues of animals of the control group 10 days after surgery showed that the wound defect was fi lled with granulation tissue at an early stage of maturation. After 30 days, the wound defect was fi lled with young loose connective tissue, in which there were sporadic islands of granulation tissue. In the area of the wound defect of 2 groups of experimental animals, after 10 days we detected maturing granulation tissue. Visually, the area of the lesion itself decreased. On the 30th day of the study, there was no granulation tissue, the wound defect was fi lled with fully matured newly formed and vascularized connective tissue. During the histological examination, it was found that as a result of the combined use of polypropylene mesh and stem cells, the regeneration of the wound defect is intensifi ed and its healing is accelerated.

İnkarsere Karın Ön Duvarı Fıtıklarında Üçüncü Basamak Hastane Deneyimi

Background: This study aims to evaluate the results of incarcerated anterior abdominal wall hernia cases in which we performed emergency surgery in light of the literature. Materials and Methods: The records of 124 patients who underwent emergency surgery for incarcera-ted anterior abdominal wall hernia between January 2016 and December 2019 were retrospectively reviewed. The patients' files, computer records, epicrisis reports, surgery reports, and outpatient clinic records were evaluated. Patients; Age, gender, hernia type, location, time of admission, previous hernia surgery history, affected organs, type of anesthesia applied, surgical techniques, resection status, length of hospital stay, morbidity, and mortality rates were recorded. Results: The mean age of 124 patients was 59.47 ± 17.75 (17-94) years. Of the patients, 64 (51.6%) were female, and 60 (48.4%) were male. The mean hospital stay was 4.12±3.52 (1-19) days. Thirteen (10.5%) patients had additional disease. General anesthesia was applied to 100 (80.6%) patients, and regional anesthesia was applied to 24 (19.4%) patients. 25 patients were operated on with the diagnosis of recur-rence and 99 with the diagnosis of a primary hernia. The most frequently compressed organs in the hernia sac were the omentum (64.5%) and small intestine (32.2%). Bowel resection was performed in 16 of the patients. Mesh was applied to 90 patients during the operation. The most common hernia types were inguinal, umbilical, and incisional. 31 (13.7%) complications developed in 17 patients. Sepsis, wound infection, ileus, atelectasis, and respiratory failure were the most common. Mortality was developed in 6 (4.8%) of the patients. Conclusions: This study showed that additional disease increases morbidity in hernia cases, and intestinal resection due to strangulation increases morbidity and mortality. Therefore, patients presenting with an incarcerated hernia should be operated on as soon as possible before strangulation develops.

Hernia or hernia Defect? Experimental herniology Models in Laboratory Animals

   Hernias of the anterior abdominal wall remain one of the most common surgery pathologies. There is no unified approach to modeling anterior abdominal wall hernias in the world scientific community. In order to systematize the available knowledge in this field and to contribute to the formation of a unified idea of how to create a hernia model in a laboratory animal, it seems logical to study the accumulated experience of researchers in the field of experimental herniology. We found out that hernia defects generally modeled on male laboratory rats. To understand the tissue reaction to the prosthetic material a fenestration was performed in the anterior abdominal wall (including peritoneum) except for the skin and subcutaneous fat. A replacement or prosthetic material tailored to the fenestration was sutured end-to-end into the abdominal wall. We chose laboratory rats because they are easy to take care of and cheaper than larger laboratory animals.

Development of the Acellular Dermal Matrix and Experimental Substantiation of Its Use in the Anterior Abdominal Wall hernia Repair

   Objective: To develop a biological implant that is an acellular dermal matrix (ADM), evaluate its use as a support material in tensionfree hernioplasty for ventral hernia, and compare it to that of the commercially available implant PermacolTM.   Materials and methods: ADM was derived from the porcine dermis (Landrace breed) decellularized using detergents and enzymes. The quality of devitalization was assessed in vitro. We performed sublay hernioplasty in 4-month-old Landrace pigs using ADM (experimental group) and PermacolTM (control group). The specimens were explanted on day 120 of the experiment for histological and immunohistochemical examination.   Results: All cellular elements were removed by the detergent-enzymatic treatment of the dermis; the native architecture of the dermis was slightly disrupted. The specimens of the commercially available chemically cross-linked biomaterial PermacolTM had better mechanical properties than ADM specimens; however, there were no significant differences in terms of cytotoxicity. The state of the tissues after the explantation (number of fibroblasts and endothelial cells) showed no differences in the result of using ADM and PermacolTM. In 120 days, the materials integrated into the tissues without the formation of adhesions or inflammation.   Conclusions: Our findings show that ADM does not have cytotoxic properties, has adequate biomechanical parameters to effectively reinforce supporting soft tissues, does not cause an inflammatory response during implantation, and integrates fully into tissues. Our study demonstrates the effectiveness and utility of the developed ADM in surgical treatment of anterior abdominal wall defects.

Comparison of Sublay and Onlay Mesh Repair in Terms of Post-Operative Complications

Objective: To compare Sublay and Onlay mesh repair in terms of post-operative complications among patients undergoing hernioplasty.
 Study Design: Prospective comparative study.
 Place and Duration of Study: Surgical Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2020 to Jun 2021.
 Methodology: This study was conducted on 300 patients who underwent hernioplasty for anterior abdominal wall hernias at our hospital. They were randomly divided into two groups before the surgery. Group-A received only mesh repair, while Group-B received subway repair. They were followed up for two weeks for any post-operative complications. Post-operative pain, seroma formation, hematoma formation and the presence of surgical site infection were compared in both groups.
 Results: Out of 300 patients included in the final analysis, 189(63%) were male, and 111(37%) were female. About 163(54.4%) underwent subway repair, while 137(45.6%) underwent only repair. The commonest complication observed in patients was post-operative pain 68(22.7%), followed by surgical site infection 36(12%). Statistical analysis revealed that seroma formation, post-operative pain and surgical site infection were significantly observed more in patients undergoing only mesh repair than subway repair (p-value<0.05).
 Conclusion: Post-surgical complications were commonly observed in patients within two weeks of surgery. In addition, patients undergoing Onlay mesh repair were more prone to have seroma formation, post-operative pain and surgical site infection than those undergoing Sublay repair.

Issues and challenges in the surgical treatment of anterior abdominal wall hernias. Review

The literature review discusses contentious issues and challenges that arise in the surgical treatment of anterior abdominal wall hernias. The author identified the causes of hernia formation and examined the dynamics of change in the pattern of hernia incidence. An analysis of the factors that contribute to the development of incisional ventral hernias was given special consideration. The causes of hernia recurrence were also studied. The entire spectrum of existing classifications of primary and incisional ventral hernias was reviewed, along with their advantages and disadvantages. Evaluation of current recommendations regarding the use of additional imaging methods for the examination of patients with ventral hernias was carried out. In the study, considerable attention was paid to surgical methods for hernia treatment. The advantages and disadvantages of “open” and minimally invasive laparoscopic hernioplasty techniques were critically evaluated. The difficulties in selecting an intervention method for certain types of hernias, including large ones, were highlighted, as was the importance of preventing hernia recurrence.
 It has been established that there are still many unsolved problems in the surgical treatment of anterior abdominal wall hernias. The author justified the need for a standardized approach to determining the characteristics of anterior abdominal wall hernias and their further classification. It is necessary to study the effectiveness of using imaging methods (ultrasound, computed tomography) for ventral hernias, depending on their size and location. There is a need for wider implementation of laparoscopic hernioplasty techniques, and the degree of the hernial defect should be taken into account when determining the indications for surgical intervention. The possibility of using laparoscopic hernioplasty for large hernias, as well as for hernias associated with rectus abdominis diastasis, requires further investigation. Improving management strategies for patients with anterior abdominal wall hernias is critical in order to reduce the risk of hernia recurrence and complications.

Anterior abdominal wall reconstruction in patients with midline ventral hernia

Introduction. Simultaneous hernio-abdominoplasty allows solving a complex of problems of the anterior abdominal wall in one surgical intervention. Th e relevance of this issue is determined by the lack of a unified algorithm for solving the combinations of anterior abdominal wall pathologies and by the presence of a number of complications, both in isolated and combined surgical techniques.Aim. The present paper analyzes the treatment results of patients undergoing simultaneous surgery for ventral hernia and deformations of the anterior abdominal wall.Materials and methods. Th e study enrolled 17 women (mean age 35.6 ± 7.0) undergoing inpatient and outpatient treatment in the Department of Plastic Surgery, Mother and Child Clinical Hospital, Ufa, in the period from 2019 to 2022. All patients had various aesthetic deformations of the anterior abdominal wall (laxity and excess skin, skin-fat apron, diastasis of the rectus abdominis muscles, excessive fat deposits) and midline ventral hernia of various sizes. 100 % patients had a history of pregnancy and childbirth; 64.7 % – grade 2 and 3 obesity.Results and discussion. Two cases (11.76 %) showed local complications as hematoma of the epigastric region and necrosis of the navel. In the first case, this can be explained by the fact that extensive liposuction of the anterior abdominal wall was performed, and in the second – by the presence of a multidefect ventral hernia of large size, in particular, an umbilical hernia with dimensions of 15x8 cm. Complications were mitigated on an outpatient basis within a period of 1.5 to 3 months by means of conservative therapy and physiotherapy.Conclusion. All patients were satisfied with the obtained aesthetic result

Evaluation and clinical significance of predictors for strangulation and intestinal resection in emergency anterior abdominal wall hernia surgery.

Emergency anterior abdominal wall hernia surgery plays a pivotal role in emergency general surgery practice. In this study, the predictive value of laboratory and imaging findings as well as demographic information and comorbidities of the patients for the recognition of strangulation and intestinal resection was investigated. Patients over the age of 18 who were operated consecutively with an indication for emergency anterior abdominal wall hernia surgery between January 2017 and December 2019 in a single tertiary hospital were included in this retrospective cohort study. The patient population was divided into two groups according to the pre-operative findings during the emergency anterior abdominal wall hernia surgery. Group 1 consisted of cases with incarceration but without strangulation, whereas Group 2 consisted of cases with strangulation in addition to incarceration. Moreover, in evaluation for the requirement for intestinal resection, patient Group 2 was divided further into two groups, namely, as Group (1 or 2) a and Group (1 or 2) b, defining the need for intestinal resection. A total of 106 patients who had emergency anterior abdominal wall repair surgery due to incarcerated hernias were included in the study. The evaluation of the indices related to systemic inflammation revealed that lactate dehydrogenase to white blood cell ratio was significantly lower but neutrophil to platelet and neutrophil to albumin ratios were significantly higher in patients with strangulation, showing the significance of those systemic inflammation indices in detecting strangulation (p=0.027, p=0.035 and p=0.030, respectively). Moreover, the analysis of the patients in whom intestinal resection was required (Group 2a vs. 2b) exposed that neutrophil to albumin ratio was significantly higher in the patients with intestinal resection (p=0.036). Indices of systemic inflammation such as lactate dehydrogenase to white blood cell ratio, neutrophil to platelet ratio, and particularly neutrophil to albumin ratio may be potentially beneficial to prevent complications and improve clinical outcomes in emergency hernia surgery.

P-129 TRAUMATIC HERNIA, URGENT REPAIR?

Abstract Aim We present our clinical experience in the urgent repair of traumatic hernias through two clinical cases. Material and Methods Case 1: A 45-year-old man suffering thoraco-abdominal trauma due to running over. Thoracoabdominal CT scan and surgical examination shows a meso tear of terminal ileum and traumatic section of the right lateral musculature. Case 2: A 19-year-old man suffering abdominal trauma due to a traffic accident. CT abdomen is performed which reports large traumatic hernia of the left anterior abdominal wall including intestinal loops, with pneumo and retroneumoperitoneum. Results Case 1: We close the mesenteric gap and repair musculature by associating a polypropylene mesh in the preperitoneal space. The patient is discharged after 13 days. During the two-year follow-up, no hernia recurrence was detected. Case 2: A reconstruction of the wall is performed associating posterior separation of left components, in addition to ileocecal and sigma resection with anastomosis. As a complication presents seroma and chronic sinus, without hernia recurrence during follow-up for 5 years. Conclusions The tendency in traumatic hernias is their repair in a second time attending first to injuries that compromise the survival of the patient, but larger defect can lead to irreversible sequelae since enlargement of hernia, atrophy and muscle retraction, resulting in a more complex repair. If the patient requires urgent surgical intervention for visceral injury, some authors defend the simultaneous repair of the hernia in stable patients. Our group thinks that patients requires individualized management and its urgent repair will depend on the clinical situation.

S2633 Omental Varices Causing Umbilical Bleeding: A Rare Presentation in Cirrhotic Patients With Portal Hypertension

Introduction: Ectopic varices account for less than 5% of all varix-related bleeding episodes. Umbilical bleeding is a well-recognized but unusual complication of portal hypertension, and most of the time is caused by bleeding from umbilical varices (UV). On the other hand, rupture of omental varices (OV) leading to spontaneous umbilical bleeding is rare and has been reported once in the previous literature. Case Description/Methods: A 54-year-old male with a history of liver cirrhosis, MELD score of 21, Child-Pugh Class B, who was found lying in a pool of blood in his bedroom, was transported to the hospital with profuse spontaneous bleeding from his umbilical hernia site. He gave a history of similar, but mild bleeding episodes occurring intermittently over the last week, with no trauma associated. Initially, the patient was hypotensive, tachycardic, and had a protuberant abdomen with a large ventral hernia, covered by a dressing. Removal of the dressing revealed active venous hemorrhage. Laboratories showed hemoglobin 6.9 g/dL, mean corpuscular volume 95.3 fL, platelets 88 × 103/mcL, INR 1.36, total bilirubin 0.7 mg/dL, ammonia level 160 µg/dL, and mild transaminitis. The patient’s hemorrhagic shock was treated with blood transfusions, IV fluids, and vasopressors. Abdomen CT scan showed anterior abdominal wall hernias containing herniated fat with fat stranding. The surgery service evaluated the patient and suspected OV bleeding. Intraoperatively, he was treated with periumbilical excision and ligation of the OV contained within the hernia. The omentum became adhered to the skin of the umbilicus, allowing venous communications to develop between the varices and cutaneous veins of the umbilicus. The section was dissected and a Seprafilm was placed to prevent future adherence, and the bleeding was controlled (Figure 1). Discussion: The most reported cause of spontaneous umbilical bleeding is UV. In our case, the presence of bilateral anterior abdominal hernias containing herniated fat with some fat stranding on the abdominal CT was suspicious for OV, which was confirmed to be the source of bleeding intraoperatively. In such cases, OV as the source of umbilical bleeding should be ruled out. Previous reports have suggested a portosystemic abdominopelvic CT scan preoperatively to define the portal vascular anatomy, identify associated varices, and sites of bleeding before the procedure.Figure 1.: CT Abdomen and pelvis without contrast showing umbilical hernia containing omental fat.

A Prospective Observational Study of Ventral Hernia.

BackgroundVentral hernias are commonly encountered problems in the field of general surgery. Incisional hernia is a common complication following abdominal surgery that requires reoperation. This study was conducted to understand the incidence of various types of ventral hernia in both sexes and various age groups, predisposing factors, clinical features, and complications.MethodsThis prospective observational study was conducted in the Department of Surgery, Dr. Hedgewar Hospital, Aurangabad, Maharashtra, India, on a total of 100 patients diagnosed with anterior abdominal wall hernia between September 2020 to February 2021. Data collection included thorough history taking and clinical examination along with relevant investigations. The data collected was entered in a proforma, tabulated, and analyzed with the IBM SPSS Statistics for Windows, Version 24.0 (Released 2016; IBM Corp., Armonk, New York, United States).ResultsIncisional hernia (43%) was the most common of all ventral hernias. Females were much more affected than males. Out of these types studied, epigastric hernia showed more incidence among males. The average age of presentation was 52 years. Obesity was the most common predisposing factor (34%) with female preponderance. Obese patients were also associated with a higher rate of postoperative complications like wound infection and seroma. In the cases of incisional hernia, 32.6% of the patients gave a history of previous surgery complicated by a wound infection. Incisional hernias were more common in lower midline incisions (34.9%) and after gynecological surgery (55.81%) like total abdominal hysterectomy, cesarean section, or tubal ligation. In the majority of the patients (62.8%), the incisional hernia occurred within three years of the previous surgery. Wound infection following ventral hernia repair occurred in 11% of the cases, wound dehiscence in 3%, and seroma in 2 % of the cases.ConclusionsThe most common ventral hernias in decreasing order of their frequency are incisional hernia, umbilical hernia, para-umbilical hernia, and epigastric hernia. Epigastric and umbilical hernias are more common in males whereas incisional hernia is more common in females. Obesity and constipation were found to be the major predisposing risk factors. Incisional hernia is more common in females after gynecological and obstetrics surgery. The lower midline segment is the most common site for developing an incisional hernia.

Pharmacological Regulation of the Inflammatory Response under Mesh Implant Prosthetics in the Treatment of Patients with External Abdominal Hernias

Introduction. Seromas and hematomas of the implantation area are among the most common complications in prosthetic repair of a hernia defect with a mesh implant. The adequate tissue inflammation response to prosthesis implantation is achieved by the local protective role of pro-inflammatory cytokines. With suppression of the body's immune system combined with existing comorbidities, mesh implants result in even greater suppression of the immune system, which is manifested by an inadequate inflammatory response, both local and systemic, leading to the development of complications.Previously, the authors studied the effect of pyrimidine preparation "Xymedon" (INN - hydroxyethyldimethyldihydropyrimidine) on the systemic inflammatory process after prosthetic repair of anterior abdominal wall hernias. Based on the results of the interim study, it was hypothised: Regulation of the inflammation response to prosthesis implantation in hernioplasty manifested by changes in cytokine concentration in the blood can reduce postoperative complications. The aim of the study was to reduce the number of postoperative complications in prosthetic hernioplasty by regulating inflammatory reactions that occur after mesh implants.Materials and methods. Experimental part of the study. The experiment involved 66 rats, both sexes, pure line, which were implanted with mesh prostheses. Animals in group I (n=33) the control one - received 1 ml of 0,9% sodium chloride solution, i.e. received no specific treatment. Animals in group II (n=33) - the main one - received "Ximedon" 21 mg/day as pharmacological support. Blood sampling to determine inflammation markers was performed on the 5th day after the intervention. Animals were withdrawn from the experiment and the implantation site was taken for histological and histomorphometric investigations on the 5th day of the study. The study was carried out in the SPF vivarium at the laboratory of the Center for Genetic Collections of Laboratory Animals, Lobachevsky State University of Nizhny Novgorod. The study consisted of 4 series of experiments (2018-2021). Clinical part of the study. Prospectively (2018 - February 2022), we analyzed clinical outcomes of 101 patients with prosthetic repair (by Liechtenstein, TAPP, eTAR, "sublay") of an aponeurosis hernia defect of the anterior abdominal wall who received treatment in the City Clinical Hospital №7 named after E.L. Berezow. Patients of the "control" group (n=33) received only conventional treatment; patients of the "Ximedon" group (n=68) received 0.5 mg of ximedon 3 times a day for 10 days orally from the first day after the operation. Blood sampling was carried out on the 5th day after surgery. The data obtained were processed and structured using Microsoft Excel 2019 (64 bit), and statistical values were calculated in StatSoft Statistica 12,5 (64 bit).Results. Xymedon has a significant effect on the increase in the area of ​​the vessels of the implantation area in the experiment. Its use is associated with a lower level of C-reactive protein and blood IL-6 on day 5 in the experimental group compared to the control group. In the clinical study ximedon has a significant effect on the cytokine concentration in the blood: C-reactive protein, TNF-a, interleukins 6, 8 and 10. In the experimental study the dynamic of C-reactive protein, blood interleukins 6 and 10 does not significantly differ from the clinical one. In the clinical study, xymedon intake was associated with fewer postoperative complications. Conclusion. The studies performed allow us to consider "ximedon" as a means of pharmacological support for prosthetic repair in external abdominal hernias due to a significant reduction in postoperative complications provided by the ability to regulate inflammation reactions and stimulate reparative regeneration.

STUDY OF LAPAROSCOPIC VENTRAL HERNIA REPAIR IN A SINGLE INSTITUTIONAL SETUP

Objective: Incidence of Ventral hernias or anterior abdominal wall hernias is about 2-13% worldwide. Laparoscopic ventral hernia repair (LVHR) technique has proven to be effective treatment option with reduced complications. This study aims to assess the feasibility and outcome of LVHR in a government set up. A prospective observational study of patients of a single government institution was conducted. Surgical technique,Methods: Long- term outcomes such as pain, mesh infections, bowel adhesions, recurrence and feasibility were assessed. Mean age of studyResults: patients was 44.45 years, with highest incidence (33.33%) in the age group of (31-40) years. Male: Female ratio was 1: 2.529. Obesity accounted for predominant risk factor (15 %). Around (31.67 %) patients had other co morbidities like diabetes, hypertension, obesity, COPD and pulmonary tuberculosis. Incision hernia accounted for (50 %). Remaining (50 %) include the epigastria hernia, umbilical hernia, traumatic hernia and spigelian hernia. 44(73.34%) patients had defect size between (2-5) cm, 11(18.33%) patients between (5-10) cm and 5(8.33%) patients less than 2 cm. Mean defect size was 3.51 cm. 54 patients (90 %) having defect size more than 2 cm were operated by laparoscopic Intra peritoneal on lay mesh repair. 6 (10%) patients having defect size less than 2 cm operated by Laparoscopic fascial closure by intracorporeal suturing. Mean surgical time was 55.17 minutes. (Range 40 - 110 minutes). Mean postoperative hospital stay was 2.25 days. 65% of patients got discharged after 2 days. Total 8 (13.33%) patients developed complications which were managed conservatively. 1 (1.67%) patient developed recurrence. There were no mortality and minimum morbidity observed. Although we cannot conclude regarding cost factor, we can vouch that all patients with anyConclusion: primary ventral hernia should have the repair performed by the laparoscopically if technically feasible. Laparoscopic ventral hernia repair is feasible, effective and can be performed as short stay surgery even in government set up.

Factors Associated with Development of Ventral Hernias and Healthcare Seeking Behaviors in a Cohort of Pakistani Women

Background: Anterior abdominal wall hernias constitute one of the most common surgical presentations. According to the World Bank data Pakistan has one of the highest birth rates per woman in the region at 3.6 births per woman. In Pakistan there has also been a large increase in C-section rates with nearly 20% of all pregnancies being delivered via C-section, nearly 1 out of every 5 births. Multi-parity is a risk factor for developing paraumbilical hernias and C-sections lead to incisional hernia developments. Methodology: The study conducted was a cross-sectional study at a tertiary care hospital in the department of surgery from 1st June 2021 till 1st September 2021. Any woman presenting with a ventral hernia to the clinic was asked to fill out a questionnaire. 60 women presented over the study period and were enrolled. Results: Fifty five percent paraumbilical hernias and 41.7% incisional hernias were reported. The mean number of pregnancies was 4.10 S.D 1.531 with a range from 0-8. C-sections were 2 times more common than SVDs. Increasing number of pregnancies associated with younger age of onset. Higher number of vaginal deliveries and C-sections were each associated with the development of a ventral hernia. Conclusion: The high fertility rate and C-section rate in Pakistan incurs a huge risk to women developing ventral hernias and poses a burden to the public healthcare system. Keywords: Paraumbilical hernia; parity; Pakistan

Use of botulinum toxin type A in giant ventral postoperative hernia

Postoperative ventral hernia represents one of the causes of anterior abdominal wall hernias. Repair of this hernia can be very challenging for surgeons, as they are associated with cardiovascular and respiratory complications, development of compartment syndrome, and high recurrence rates. Our case is a 48-year-old woman was operated on twice. The first time was in 2015 due to perforation of colonic diverticulitis for which abdominal exploration and Hartmann’s procedure was performed. In 2016, the reverse of Hartmann’s procedure was done. Forty days after the second operation, she noticed a small hernia in the scar area that increased rapidly. After 1 year, it became irreducible with dimensions (30X17 cm) reached the para-umbilical region without any sign of intestinal obstruction. We decided to do hernioplasty using self-gripping mesh. Six weeks before surgery, botulinum toxin type A was injected intramuscularly to induce muscle weakness and restore the normal biomechanics of the anterior abdominal wall, facilitating closure and repair. Postoperative results and follow-up after 6 months were satisfactory.

Sublay and overlay mesh repair in paraumbilical hernias– which surgery you will prefer??

Background: Paraumbilical hernia accounts for 33.9% of anterior abdominal wall hernia. Mesh can be applied onlay; on the anterior fascia, inlay; in the hernia defect, sublay; to retro-rectus or preperitoneal space or underlay; in the intraperitoneal position. Aims and Objectives: The objectives of the study are as follows:1) To compare the efficacy between sublay and onlay mesh repair for paraumbilical hernia. 2) To compare the safety between sublay and onlay mesh repair for paraumbilical hernia. Materials and Methods: A prospective study was conducted on 120 patients (60 in each group) patients. The patients were randomly allocated in two groups by lottery method. Patients in Group-A were subjected to sublay mesh repair procedure and patients in Group-B were subjected to onlay mesh repair procedure for paraumbilical hernia repair. Postoperatively, every patient was kept under observations for 3–4 days in ward and observed for complications. Postoperatively, all patients were followed at 10 days, 3 months, and 6thmonth to confirm efficacy and safety of the procedure. Results: The average age of Group-A was 39 years and 32 years in Group-B. In Group-A, 55% patients were female and 45% patients were male; whereas in Group-B, 60% patients were female and 40% patients were male. More over sublay mesh repair was effective in 82% patients on the bases of recurrence while this procedure was safe in 90% cases on the bases of complications whereas onlay mesh repair was effective in 90% patient’s cases on the bases of recurrence while this procedure was safe in 93% cases on the bases of complications. Conclusion: Onlay mesh repair technique is more effective, quick, and safe as compared to sublay mesh repair technique for the treatment of paraumbilical hernia.

Manual Reduction of Incarcerated Abdominal Wall Hernias. A Feasible Option during COVID-19 Pandemic: A Prospective Study.

Background  Incarcerated hernia is a common surgical emergency with considerable morbidity or even mortality. Manual reduction (taxis) and elective surgery could be an alternative management approach. This study examines the role of taxis with the adjuvant use of the visual analogue scale (VAS) score in treating incarcerated hernias and thereby decreasing the emergency surgery rate, especially during the novel coronavirus disease 2019 (COVID-19) pandemic. Methods  All adult patients admitted to the emergency department of our hospital with incarcerated hernias of anterior abdominal wall were prospectively submitted to hernia manual reduction. The VAS score was used as an adjuvant tool for monitoring the success of this maneuver. Patients with successful taxis and low VAS score were hospitalized for a 24-hour period of observation. On their discharge, they were scheduled for an elective hernia repair. Patients with unsuccessful taxis or with less than a 50% reduction in VAS score after successful taxis were submitted to emergency surgical repair. Age, sex, type of hernias, time until taxis, VAS scores before and after taxis, length of hospital stay, and adverse events for both groups were recorded. Results  Between September 2018 and September 2020, 86 patients with incarcerated hernias were included. The types of hernias were incisional in 8 patients, umbilical in 15 patients, inguinal in 56 patients, and femoral in 7 patients. Taxis was successful in 66% of patients with a mean reduction in VAS score from 83 to 17 mm. Following successful taxis, patients were hospitalized for a 24-hour period of observation. No taxis-related complications were observed. Fifty-two patients were safely discharged from hospital and scheduled for an elective repair during the first month. Thirty-four patients were operated emergently. Five patients had successful taxis but with a reduction of posttaxis VAS score less than 50% (a mean reduction from 86 to 62 mm), while taxis failed in twenty-nine patients. Patients with emergency surgery had longer time until reduction and longer stay of hospitalization. In this group, two patients required admission to the intensive care unit while one patient died. Conclusion  In this protocolized approach, taxis is a safe and feasible option for most patients with incarcerated hernias. It should be kept in our armament, especially in times when emergency surgery capabilities are under strain like the ongoing COVID-19 pandemic.

Опыт применения симультанных операций у больных с варикозной болезнью и грыжами передней брюшной стенки

Aim: to substantiate the feasibility of concurrent surgeries in patients with varicose vein disease and anterior abdominal wall hernias (ventral hernias). Patients and Methods: the paper presents the treatment results of 82 patients with ventrial hernias and lower limb varicose vein disease. The method choice and the scope of surgical intervention were determined on the basis of clinical and instrumental examination data. Commonly, Lichtenstein tension-free hernia repair in combination with crossectomy, endovasal laser coagulation (EVLC), varicose veins radiofrequency ablation (VVRFA) were performed. The long-term results were analyzed 1–2 years after the use of concurrent surgeries. The life quality before surgery and a year after was determined by the SF-36 questionnaire. Results: the patients consisted of 45 (54.9%) men and 37 (45.1%) women aged 19 to 69 years. In 20 (24.4%) of the admitted patients, work was associated with physical activity, and 56 (68.3%) patients were at the most capable age: 19 to 50 years. Upon admission to the clinic, 78 patients had complaints. Commonly, they had a combination of varicose vein disease with inguinal or umbilical hernias. After the use of concurrent surgeries, no specific complications were observed in this patient cohort, as well as complications associated with both diseases concomitantly. In the long-term period, patients noted an improvement in their general health by 23.2%. In the preoperative period, the indicator of physical functioning was 41.27 points; after the operation, there was an increase in this indicator according to patients’ estimates by 1.6 times — to 67.32 points. After surgery, the greatest positive trend of vital activity (42.8%) and role limitations due to emotional state (57.3%) were observed. There was an increase in all indicators of life quality by 18.2–53.9% in patients who underwent concurrent surgeries. Conclusion: the obtained results demonstrated the safety and high efficacy of concurrent surgeries in patients with varicose vein disease and ventral hernias. Thus, the use of concurrent surgeries is considered to be an alternative to the staged treatment of patients with varicose vein disease and ventral hernias KEYWORDS: concurrent surgeries, varicose vein disease, ventral hernias, life quality, postoperative complications. FOR CITATION: Chernookov A.I., Kuznetsov M.R., Kandyba S.I. et al. Concurrent surgeries in patients with varicose vein disease and ventral hernias. Russian Medical Inquiry. 2022;6(4):164–170 (in Russ.). DOI: 10.32364/2587-6821-2022-6-4-164-1.