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Ilhom Hayitov, assistant, department of Surgical disease for GP Tashkent Medical Academy E-mail: ilhom.med79@mail.ru.
The quality of life of patients with postoperative and ventral hernias and abdominal obesity before and after surgery
Abstract: Treatment treatment of postoperative and ventral hernias in patients with obesity affects not only surgical but also a number of social problems. The quality of life of patients in the late period after the removal of the ventral hernia is different from the average population indicators and does not depend on the chosen method.
Keywords: postoperative and ventral hernias, quality of life, anterior abdominal wall, abdominoplasty.
Relevance. The social significance of the problem and surgical treatment of postoperative and ventral hernias (POVH) exacerbates the fact that the largest number of patients with age ranging from 40 to 60 years, i. e., working age [3, 55-56]. 46% of patients operated on for POVH engaged in physical labor, and are in need of total rehabilitation [4, 138]. Among patients women prevail — 67.8% [5, 6263]. The most common hernias occur in individuals
with a cone-shaped [6, 3-7] and spherical shape of the abdomen, mostly located in the cut hypogastric region [8, 14-15].
Contributing factors of recurrence POVH is obesity [8, 14]. Patients with obesity POVH varying degrees ranging from 50 to 70% [7, 37-39]. Of all patients with postoperative and ventral hernias and in 34% of patients had morbid obesity in 23% of cases had recurrent hernia [14, 199-201]. With
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The quality of life of patients with postoperative and ventral hernias and abdominal obesity before and after surgery
obesity comes an atrophy of muscles of the anterior abdominal wall and hyperextension aponeurotic and fascial layers [15, 1869-1873]. Obesity, on the one hand, predispose to the formation of a hernia, other — it progresses in its appearance [16, 6-7]. That is, obesity — an etiological factor in the occurrence or recurrence of hernias [10, 240]. Some authors believe that the skin and fat “apron” in patients with obesity stand out as an independent cause of the formation of primary hernias, because it creates a constant static load on the fascia [11, 26].
Treatment POVH in patients with obesity affects not only surgical but also a number of social problems. [1, 39-40]. The quality of life of patients in the late period after the removal of the ventral hernia is different from the average population indicators and does not depend on the chosen method of plastics [12, 415]. Application of mesh explant has no advantages over other methods of plastics in terms of quality of life [2, 476]. Based on this study the quality of life of patients operated on after various methods hernia abdominoplasty we consider unsatisfactory [13, 44-47].
An analysis of the current literature shows that not identified the best way to hernia repair with abdominoplasty. On the other hand, related to the need to remove the pendulous abdomen surgeons controversial: some consider abdominoplasty hernia repair with justifiable, others on the contrary, believe that it is only prolongs the operation, increases the wound surface and increases the risk of local complications [9, 69-74]. Therefore, we studied retrospectively the results of hernia repair without abdominoplasty and hernia repair in patients with obesity. We studied the complications, relapse, quality of life parameters in patients with obesity POVH after hernia repair with abdominoplasty and without abdominoplasty.
Objective: To evaluate the parameters of the quality of life of patients with postoperative ventral hernias with obesity after hernia repair with and without abdominoplasty.
Material and Methods: From January 2007 to 2014. in surgical department of city hospital № 1 of Tashkent there were operated 237 patients with POVH anterior abdominal wall, in the age of 1982 years. In 174 (73.4%) patients were accompanied
by varying degrees of obesity (BMI 28 to 60.9). The inclusion criterion was the presence of abdominal obesity and POVH varying degrees, exclusion criterion — recurrent inguinal and femoral hernia.
Patients were divided into two groups. The control group (90 patients), operated from 2007 to 2009, who underwent hernia repair with plastic prosthetic materials. The main group (84 patients) who underwent complete surgical treatment of hernia repair with prosthetic material abdominoplasty between 2009 and 2014. Long-term results of abdominoplasty hernia repair without POVH studied in 42 (46.6%) patients out of 90 operated patients. Term monitoring of patients ranged from 3 months to 4 years. Long-term results with abdominoplasty hernia repair POVH studied in 46 (54.7%) of 84 patients were operated. Term monitoring of patients ranged from 3 months to 3 years. Patients were called in for a check-up by telephone, on which were 27 (32.1%) patients who underwent hernia repair with abdominoplasty, and 20 (22.2%) patients undergoing surgery without abdominoplasty. The remaining 19 (22.6%) patients of the main group and 22 (24.4%) patients in the control group completed questionnaires (containing specific questions) during a conversation on the phone.
One measure of the effectiveness of the treatment is to improve the quality of life. The study baseline efficacy in patients of the control group and the main based on completing a special questionnaire «SF-36 Health Status Survey», which shows a significant reduction in physical and mental health component. The general health of patients is very low and only 32.6% of the patients indicated a satisfactory state of health. 25% of respondents pointed to the preservation of mental health, role functioning due to emotional state, was even lower, and 14% of irrigated patients indicated it satisfactorily. It is associated with low activity of social functioning and vitality, so the majority of patients were quite passive way of life, dominated by physical inactivity. Only 40% of the patients to live a normal career, and V of the respondents pointed to the safety of the patients vitality. This quality of life of patients is in direct relation with the size of the hernia defect, the degree of ptosis and obesity.
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Quality of life was assessed immediately before Health Status Survey» (Ware JE, 1993) relating to
surgery and within the period of 3 months to 3 years the non-specific questionnaires to assess quality of
after hernia repair with abdominoplasty. To do this, life, these data are given in Table 1. patients filled special questionnaire — «SF-36
Table 1. - The quality of life study group before and after gernioabdominoplasty (n = 84)
General index The overall scale Preserving the function (%)
Before surgery After surgery
The physical health component (Physical health — PH) Physical functioning 37,56±6,56 80,23±10,45
Role functioning due to physical state 16,78±8,56 84,34±21,34
Pain intensity 42,17±5,54 64,56±11,76
General health 30,09±6,26 61.62±10,23
Психологический компонент здоровья (Mental Health — MH) The psychological component of health 31,70±6,06 80,11±9,10
Role functioning due to emotional state 20,86±7.45 88,45±7,42
Social functioning 41,54±9,39 61,67±6,32
Vital activity 23,94±8,63 79,34±8,39
As the table shows, the physical health component was characterized by a significant decrease in physical functioning, role, due to a physical condition before treatment. In addition, each patient complained of pain so intense pain were assessed as moderate. The general health of patients is very low and only 32,55 ± 14,34% ofpatients indicated a satisfactory state of health.
The psychological component of health in patients with POVH was also rated as very low in the preoperative period. Thus, only У of patients indicated the safety of mental health. Role functioning due to emotional state, was even lower with only 14% of respondents pointed to his patients is satisfactory. This is due to low activity of social life of patients, with the majority of the patients were relatively passive way of life, dominated by physical inactivity. Only 40% of the patients to live a normal career, and У of the respondents indicated only for the safety of vital activity. Consequently, the initial quality of life of patients was quite low as a result of low physical and mental components of health. The quality of life of patients is directly related to the magnitude of the hernia defect, the degree of ptosis and obesity. Given these facts, we estimated the quality of life of patients with POVH late after hernia repair with abdominoplasty.lt was found a significant improvement in the quality of life of operated patients. For example, physical activity in the study group increased 9.06 times. In this case, 2 times reduced the number of patients
complaining of pain in the hernia protrusion, discomfort in the area and not least the appearance of most patients satisfied.
The same positive trend was noted in the psychological component of health. For example, 80% of patients in the postoperative period pointed to a good mental state of the operated patients, in 3.04 times higher relative to the performance of treatment. To improve the psycho-emotional background, indicated 88% of operated patients that 3.36 times the original value. On the preservation of social functioning and vitality indicated 62 and 79% of the patients, in 1.55 and 3.25 times more than those who for some reason refused the proposed surgery (tab. 2).
Thus, the quality of life of patients after hernia repair surgery with abdominoplasty is greatly improved. At the same time increase physical activity of patients, the possibility of self-service, the basic pathology did not significantly affect the performance of certain physical activities. In addition, the improvement of the general health, absence of cosmetic defects and reducing pain improved the emotional state of patients, contact with others, significantly decreased the number of patients with depression, isolation and others.
Analyzing the physical and mental status in both the test data, the proposed method of treatment indicated in 1.43 and 1.26 the best indicator of the physical status of patients who underwent abdominoplasty.
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The quality of life of patients with postoperative and ventral hernias and abdominal obesity before and after surgery
Table 2. - The quality of life of patients after surgery abdominoplasty hernia repair with or without
General index The overall scale Preserving the function (%)
hernia repair without abdominoplasty hernia repair with abdomino-plasty
The physical health component (Physical health — PH) Physical functioning 56,23±4,76 80,23±10,45
Role functioning due to physical state 66,76±6,65 84,34±21,34
Pain intensity 52,15±3,37 64,56±11,76
General health 50,87±8,23 61,62±10,23
The psychological component of health (Mental Health — MH) The psychological component of health 33,54±8,36 80,11±9,10
Role functioning due to emotional state 31,44±9,78 88,45±7,42
Social functioning 46,43±7,63 61,67±6,32
Vital activity 27,76±6,86 79,34±8,39
Therefore, if 56% of patients operated without abdominoplasty basic health does not interfere with their daily work, when combined with abdominoplasty this figure increased to 80%. The intensity of pain in both groups was similar. The number of patients is indicative of good health, were 1.21 times more than with conventional operations.
The mental health component was also higher in patients undergoing hernia repair with abdominoplasty. Thus, the number of patients with normal mental health were 2.4 times higher than in patients without abdominoplasty, ie if the number of patients with depression, anxiety and mental ill feelings in the group without abdominoplasty was 66.5%, whereas in the proposed treatment, this figure has increased significantly. And only in 31.5% of operated without abdominoplasty emotional state does not interfere with daily operations, while in the group of patients undergoing hernia repair with abdominoplasty, the figure was 1.81 times higher, amounting to 88.5%.
More than 50% of patients with traditional hernia repair remained significant limitations of social contacts, reduce the level of communication in connection with the deterioration of the physical and emotional state, whereas in patients with abdominoplasty, it decreased by 38% of patients in the late postoperative period, which is 1.4 times became less common.
In the group of patients with hernia repair without abdominoplasty only 27.8% of patients in the remote periods after surgery feel themselves full
of vigor and energy, 72.8% complained of fatigue, decreased vitality. At the same time in the group of patients operated with abdominoplasty, the number of patients with high vital activity was 2.86 times higher. Consequently, abdominoplasty hernia repair with significantly improved quality of life of patients. An increasing number of patients with preservation of physical and mental components of health, most of them returned to active work, there are signs of emotional satisfaction.
Quality of life of patients after hernia repair surgery have improved, increased physical activity of patients, the possibility of self-service, the basic pathology did not significantly affect the performance ofcertain physical activities. In addition, the improvement of the general health, absence of cosmetic defects and reducing pain improved the emotional state of patients, contact with others, significantly decreased the number of patients with depression, isolation and others. However, despite these positive developments, full recovery was not observed.
Quality of life study group was significantly higher than the control. Thus, the preservation of the physical component of health, including physical functioning and role functioning due to physical condition, with the proposed method of treatment indicated in 1.43 and 1.26 are more likely than those without abdominoplasty. If 56% of patients operated without abdominoplasty basic health does not interfere with their daily work, when combined with abdominoplasty this figure increased
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Section 1. Clinical medicine
to 80%. The intensity of pain in both groups was similar. The number ofpatients is indicative ofgood health, were 1.21 times more than the control.
The mental health component was also higher in patients undergoing hernia repair with abdominoplasty. If the number of patients with depression, anxiety and mental ill feelings in the group without abdominoplasty was 66.5%, whereas the proposed treatment — only 20%. More than 50% of patients in the control group remained significant limitations of social contacts, reduction of communication due to the deterioration of physical and emotional state, whereas in the group with abdominoplasty, it was detected in 38% of patients. In the group of patients with hernia repair without abdominoplasty 72.8% of respondents complained of fatigue, decreased vitality. At the same time in the group of patients operated with abdominoplasty hernia repair in patients with high numbers of vital activity was 2.86 times higher.
Summarizing the findings it can be said that, with the hernia repair in patients with abdominoplasty POVH by obesity significantly improves outcomes, reduces the frequency of general and local early and late postoperative complications and mortality. This is confirmed by the increasing number of patients with preservation of physical and mental components of health and return them to the active work, reduce depression and suggestions about the incurability of the underlying pathology. All of the above testifies to high efficiency of the proposed method of treatment POVH on the background of obesity and calls for its widespread introduction into clinical practice.
Clinical Example № 3.
Patient P., 52 years old, and/W 6753 received 26.04.2014, with the diagnosis of postoperative ventral
ERF In
hernia, ptosis of 2 degrees. Height 156 cm, weight 81 kg, BMI 33.2 kg/m2. Type of obesity — genoidnoe reason — alimentary. Concomitant diseases: hypertension 1 tablespoon and chronic bronchitis. Received appropriate treatment.
From history 15 years ago was made laparotomy. The patient then was thin, slender. After that, the patient recovered. After 5 years after surgery appeared hernia in postoperative scar. The patient connects the appearance of a hernia with obesity. Gradually I began to increase in hernia volume. During these years, she added weight. The last 2 years was accompanied by a hernia pain became often bother to interfere with walking. By all measures, the quality of life has deteriorated.
When you receive a general state of moderate severity.
Locally: In midline abdominal wall there are n/a scar the size 18h2.0 sm giant hernia the size of 20x20 sm.
In order to prepare a thorough preoperative examination:
Complete blood count: HB — 128 g/l, er. — 3.5., Layk — 7.4., NT — 37%., T-t — 4st., fib. A -3.95 g/l.
Biochemical tests: ALT — 0.68 mmol/l, total protein — 72.4 g/l.
ECG — heart rate, 78 min., Sinus rhythm, moderate left ventricular hypertrophy.
TSMW-without features.
ERF (External respiration function) — chronic bronchitis for obstructive type.
Diagnosis: Postoperative ventral hernia. M. W4. R1. Obesity I st. (BMI 33.2). ptosis. (Mean ptosis).
Concomitant Hypertension.: 1 tbsp. Chronic bronchitis.
The patient was examined by a physician, pulmonologist and the anesthesiologist.
Parameters Norms Before operation Post operation
VC (L) 2.41 1.70 2.12
FVC (L) 2.31 1.78 2.08
FEV (L) 1.92 0.89 1.12
Power exhalation 5.50 2.87 3.90
The flow-volume 75% 4.98 2.32 3.56
The flow-volume 50% 3.35 1.29 2.56
The flow-volume 25% 1.13 0.90 1.08
MVL (l) 83.1 66 —
Operation: 28.04.2014.
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The quality of life of patients with postoperative and ventral hernias and abdominal obesity before and after surgery
Hernia repair. Reconstruction of the abdominal wall (Method Ramirez) with the surgical mesh.
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