Surgical Treatment Options for Patients with Large and Giant Postoperative Reducible Medial Abdominal Hernias

• Main Authors: Evgeniy F. Cherednikov, Galina V. Polubkova, Stanislav A. Skorobogatov, Ludmila E. Mehantjeva, Evgeniy S. Ovsyannikov
• Format: Article
• Language: English
• Published: International Medical Research and Development Corporation 2019-09-01
• Series: International Journal of Biomedicine
• Subjects: postoperative reducible medial abdominal hernias; hernioplasty; blood oxygen saturation; electromyography
• Online Access: http://ijbm.org/articles/i35/ijbm_9(3)_oa10.pdf

The aim of the study was to assess surgical treatment outcomes of patients with large and giant postoperative reducible medial abdominal hernias based on the developed algorithm for selecting the optimal method of hernioplasty. Materials and Methods: The study included 31 patients with large and giant postoperative reducible medial abdominal hernias. Before and after the operation, all patients underwent an electromyographic assessment of the functional state of the anterior abdominal wall muscles with determination of the muscle fatigue index (FI). FI≤2.4 indicated the preserved muscle function. In addition, on patients of the experimental group we performed a simulation of the postoperative situation with determination of the intra-abdominal pressure (IAP) level by measuring blood oxygen saturation (SpO2). A specific method of plastic surgery was chosen based on the obtained parameters of the increase in FI and IAP levels (a decrease in SpO2). The adequacy of the surgical treatment option was supported by monitoring the SpO2 level in the early postoperative period (Days 1, 3, and 7). Absence of a significant increase in IAP and adequate reduction in the SpO2 level indicated the proper choice of plastic technique. Results: In the patients of the experimental group, who were operated on with reconstructive plastic surgery, the average parameters of FI of the abdominal wall muscles were within 1.89|1.68|2.0 (P<0.05), which is evidence for the preservation of muscle function and an adequate choice of the surgical treatment option. In patients of the comparison group, who had been operated on with corrective methods of surgical treatment, the parameters of FI were within 2.79|2.52|3.16 (P<0.01), which is evidence for the loss of muscle function of the anterior abdominal wall. Conclusion: The proposed algorithm for choosing a method of hernioplasty based on the width of the hernia orifice and preoperative assessment of additional parameters, such as the functional state of the anterior abdominal wall muscles and the level of SpO2, in simulation of the postoperative situation allowed for a differentiated, functionally oriented approach toward the choice of surgical treatment options in patients with large and giant postoperative reducible medial abdominal hernias.