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
Введение. Согласно статистическим данным отделения пластической хирургии клинического госпиталя «Мать и дитя» г. Уфа за 2019-2022 гг., хирургические вмешательства на передней брюшной стенке занимают 3-е место по популярности. Комплексность подхода в лечении пациентов с сочетанной патологией передней брюшной стенки подразумевает необходимость замены изолированных методик на симультанное хирургическое вмешательство в данной области. Цель исследования. На основании клинических данных отделения пластической хирургии госпиталя «Мать и дитя» проанализировать опыт хирургического лечения и послеоперационного ведения пациентов с эстетической и физиологической патологией передней брюшной стенки. Материал и методы. В исследование были включены 54 женщины, находившиеся на стационарном лечение, амбулаторном наблюдении в отделении пластической хирургии клинического госпиталя «Мать и дитя» с 2019 по 2022 год. 31 из них составили 1-ю группу (лица с эстетической и функциональной деформацией передней брюшной стенки, но без грыжевого дефекта), а 23 -2-ю группу (лица с эстетической и функциональной деформацией передней брюшной стенки и наличием вентральной грыжи срединной локализации). В 1-й группе выполнялась абдоминопластика, во 2-й -гернио-абдоминопластика. Результаты и обсуждение. Абдоминопластика, как и симультанная гернио-абдоминопластика, позволяет восстановить утраченные форму и контуры передней брюшной стенки. Симультанная гернио-абдоминопластика увеличивает время хирургического вмешательства, но сокращает кратность необходимых операций и анестезиологических пособий, сроки реабилитационного периода, финансовые затраты. Абдоминопластика открывает удобный доступ для выполнения ненатяжной герниопластики. Симультанный подход в лечении передней брюшной стенки не вызвал увеличения частоты осложнений. Заключение. Симультанная гернио-абдоминопластика -оправданное хирургическое вмешательство при сочетанной патологии передней брюшной стенки. Комплексный подход способствует улучшению непосредственных и отдаленных результатов хирургического лечения.
Aim. The aim of the study is to compare the effect of pulmonary hypertension on the outcome of tricuspid valve plasty in the groups with moderate and significant pulmonary hypertension. Material and methods. The results of surgical treatment of 620 patients with cardiac valve diseases were analyzed. Pulmonary artery systolic pressure (PASP) measured by echocardiography. Two groups were distinguished: Group 1 – pulmonary artery systolic pressure ˂ 50 mmHg. – 250 patients, Group 2-systolic pulmonary artery pressure ≥50 mm Hg. – 370 patients. Depending on the method of tricuspid insufficiency correction, subgroups were identified in each group: subgroup A – suture plasty was used, subgroup B – annuloplasty ring. Mann-Whitney U test was used to compare two independent samples. Chi-square test was used to compare the percentages in the groups. Results and discussion. In group I (PASP up to 50 mmHg) pressure in the PA decreased in the postoperative period, however in the long-term period in the suture plasty subgroup (subgroup A) PASP increased (p=0.01), in the annuloplasty ring subgroup (subgroup B) PASP after surgery and in the long-term period has not changed significantly. The mean value of tricuspid regurgitation (TR) was 1.27±0.4 in subgroup B and 2.1±0.6 in subgroup A (p=0.0227). In group II (significant pulmonary hypertension), postoperative PASP decreased to 50.5±13.2 (subgroup A) and 53.4±8.0 (subgroup B) mm Hg, however in the long-term follow-up there was an increase of pressure in PA to 58.3±10.7 and 56.4±11.8 mm Hg, respectively. In subgroup B, the long-term results were better in terms of TR degree, 1.6±0.5, in contrast to subgroup A, where the average degree was 2.6±0.7 (p=0.001). Tricuspid valve (TV) plasty with a annuloplasty ring preserved coaptation of the TV cusps and prevented residual tricuspid insufficiency despite the intensity of pulmonary hypertension. Conclusion. Surgical treatment of mitral and aortic heart diseases leads to decrease or normalization of pulmonary artery pressure. Pulmonary hypertension in the postoperative period is a factor that influences the intensity of TR. All patients with significant functional TR as an outcome of left heart valve pathology should undergo TV annuloplasty. Correction with annuloplasty ring only is recommended for patients with significant pulmonary hypertension and significant TR.
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