General Surgery

doi: 10.25005/2074-0581-2021-23-2-251-261
SURGICAL TREATMENT STRATEGIES FOR GIANT ANTERIOR ABDOMINAL WALL HERNIAS

M.Kh. Malikov1, F.B. Bokiev2, O. M. Khudoydodov1, I.T. Khomidov1, F.M. Khomidov1, N.A. Makhmadkulova3

1Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
2Republican Scientific Center for Cardiovascular Surgery, Dushanbe, Republic of Tajikistan
3Department of Operative Surgery and Topographic Anatomy, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: To improve surgical treatment of giant hernias of the anterior abdominal wall (AAW).

Methods: For 152 patients with giant hernias of the AAW, various hernioplasty options were selected. Primary hernias occurred in 56 (36.8%), postoperative – in 59 (38.9%) and recurrent – in 37 (24.3%) patients. In most cases, hernias occurred in females (124), accounting for 81.5%. Postoperative (59) and recurrent (37) hernias were of large sizes. Recurrent hernias developed after conventional (28), tension-free (6) and combined (3) hernioplasty techniques, postoperative hernias were a consequence of traditional (open) cholecystectomy (51%), hysterectomy (17%), as well as after laparotomy for various abdominal organs diseases (32%).

Results: Conventional hernioplasty was performed in 72, tension-free – in 32, and combined method – in 48 patients. The choice of the operational technique depended on the hernia orifice size, the structural integrity of the musculoaponeurotic layer of the anterior abdominal wall. Onlay mesh placement was performed in 57, sublay – in 13, and inlay – in 10 patients. In the postoperative period, wound suppuration after conventional hernioplasty was noted in 3 patients, after tension-free surgery methods – in 5 patients. Hernia recurrence was recorded in one case.

Conclusion: Appropriate preoperative preparation of patients with giant hernias of the AAW prevents the development of several undesired and, sometimes, severe complications in the immediate postoperative period. Achievement of satisfactory functional results after hernioplasty largely depends on a proper choice of surgery and the structural integrity of the musculoaponeurotic layer of the AAW. Large-sized hernia orifices, especially in recurrent hernias, require the use of tension-free methods of surgery.

Keywords: Giant hernias, anterior abdominal wall, hernioplasty, tension-free methods of surgery.

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Authors' information:


Malikov Mirzobadal Khalifaevich
Doctor of Medical Sciences, Associate Professor, Head of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-7816-5521
E-mail: mmirzobadal@mail.ru

Bokiev Fatkhullo Bakhhshuloevich
Candidate of Medical Sciences, Head of the Department of Endoscopic Surgery, Republican Scientific Center for Cardiovascular Surgery
Researcher ID: ABD-4776-2020
ORCID ID: 0000-0003-2807-2324
SPIN: 5254-1132
E-mail: fathullo-@mail.ru

Khudoydodov Oyatullo Makhmadulloevich
PhD Student, Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
E-mail: doctoroyatullo@mail.ru

Khamidov Faridun Marufovich
PhD Student, Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
Researcher ID: C3900-2019
ORCID ID: 0000-0002-0759-5636
SPIN: 2266-6447
Author ID: 1094615
E-mail: faridun_74@mail.ru

Khomidov Ilkhomiddin Toirovich
PhD Student, Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
E-mail: khomidov.1991@list.ru

Makhmadkulova Nigora Akhtamovna
Candidate of Medical Sciences, Assistant of the Department of Topographic Anatomy and Operative Surgery, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-4269-6611
E-mail: malikovanigora@mail.ru

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The authors did not receive financial support from companies manufacturing medications and medical equipment

Conflicts of interest: No conflict

Address for correspondence:


Malikov Mirzobadal Khalifaevich
Doctor of Medical Sciences, Associate Professor, Head of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University

734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139

Tel.: +992 (907) 305060

E-mail: mmirzobadal@mail.ru

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