Retrospective analysis of the results of surgical treatment of patients with primary and postoperative ventral herniations under the conditions of morbid obesity

Abstract

48-78 % of patients admitted to surgical hospitals with ventral hernias are obese, which has a significant impact on the course of the disease and the postoperative period, and little is reported in the literature. Obesity, on the one hand, contributes to the formation of hernia, on the otherprogresses with its appearance. Despite the large number of surgical procedures to correct the abdominal wall, the results of surgical treatment of primary and postoperative ventral hernias, especially in morbid obesity are unsatisfactory, due to errors in choosing the optimal method of surgery indicated by the high number of complications and high recurrence. Recurrences after surgical treatment of primary and postoperative ventral hernias occur in 10-60 % of cases, which indicates that the problem of surgical restoration of the abdominal wall is still far from being solved. Objective. Conduct a retrospective analysis of the results of surgical treatment of patients with ventral and postoperative ventral hernia to determine the main risk factors for complications in patients with morbid obesity. Materials and methods. The results of surgical treatment of 183 patients operated on for primary and postoperative ventral hernia with concomitant morbid obesity in 2015-2020 combination with dermatolipectomy and liposuction. A total of 46 (25.14 %) were performed. Dermatolipectomies were performed by Kuster, Jolly, Thorek and Castansres-Goethel. Pulmonary artery thromboembolism (PE) was diagnosed in 2 (1.09 %) surgically operated: 1 (1.31 %) patient with degree I of obesity and 1 (1.72%) with degree II respectively. Abdominal compartment syndrome (ACS) was diagnosed in 4 (2.19 %) surgically operated: among them with obesity degree IIin 2 (3.45 %) patients and degree IIIin 2 (4.08 %) patients. Significantly higher frequency of wound complications was observed in patients with obesity degree II-15 (26.17 %) and degree III-16 (31.41 %). Hernia recurrence occurred in 10 (12.58 %) surgically operated with obesity degree I, in 6 (9.33 %) with degree II, and in 6 (11.82 %) with degree III. Conclusions. Performance of laparoscopic and non-tension implantation methods of hernioplasty should be a priority, especially in groups of patients with pre-existing morbid obesity degree II-III. In obese patients with degree III there is a significantly higher incidence 191 of abdominal compartment syndrome, and the simultaneous dermatolipectomy or liposuction significantly reduces the incidence of local complications and recurrences.