TENSIONED HERNIOPLASTY AND ABDOMINOPLASTY IN PATIENTS WITH MORBIDE OBESITY

Surgical treatment of hernias of the anterior abdominal wall remains an urgent problem, since hernia-bearing occurs in 4-7% of the world's population and there is no tendency to reduce the number of such patients. The aim of the study is to conduct a comparative analysis of traditional and non-tight methods of hernioplasty with hernias of the anterior abdominal wall, improve hernioplasty methods, the frequency of relapses and complications in the near and long-term postoperative periods. The problem associated with overweight has existed for a very long time, but nevertheless, advances in the treatment of obesity are very small and the number of patients with morbid obesity is growing. According to the WHO, over 30% of the world's population suffers from overweight. All factors causing excess body weight lead to a weakening of the muscular aponeurotic framework with subsequent formation of abdominal ptosis. For plastic surgery of the anterior abdominal wall in modern surgery in patients with morbid obesity, non-tensioning methods are more preferable, since according to the studies of many authors with stretch hernioplasty, the recurrence rate reaches 20-63%, while in non-tension plastic surgery it is 8-30.3%. The material of this study was 62 patients with morbid obesity who were hospitalized in the period from 2010 to 2020 in the 1st clinic of Samara State Medical Institute. In our work, all patients had ptosis of the anterior abdominal wall of III (n = 44) and IV (n = 18) degrees of obesity. The patient underwent surgery to eliminate the skin-fat apron and non-tension abdominoplasty using a polypropylene mesh, in the presence of cholelithiasis, a cholecystectomy was performed. As the results of the study showed, in 38.5% of patients there were some complications of an inflammatory nature, with somewhat more complications such as seromas, lymphorrhea and, as a result, purulent-inflammatory complications. This is due to the fact that patients underwent abdominoplasty in which a wide mobilization of the subcutaneous fat layer is performed and, accordingly, the risk of developing seromas and lymphorrhea is increased. Patients were hospitalized from 16 to 28 days. All patients were discharged in satisfactory condition with recommendations. In terms of the functional effect, due to the optimal scheme of preoperative preparation and abdominoplasty, an improvement in external respiration was noted, and there were no complications from the cardiovascular system. All patients were satisfied with the obtained aesthetic result.