Dermolipectomy and abdominoplasty in surgical treatment of hypogastric postoperative hernias in patients, suffering obesity

Abstract

Objective. To improve clinico–esthetic results of surgical treatment of postoperative ventral hernias of infra–umbilico–hypoabdominal localization and hypogastric cicatricial deformities in patients, suffering obesity. Materials and methods. The work is based on the results of analysis of perioperative investigations, conducted in 37 patients. The main group was consisted of 26 patients, suffering postoperative ventral hernias after lower laparotomies or laparoscopic interventions. In 11 patients, forming a control group, there were present the soft tissue deformities without aponeurotic defects and hernias. All the patients have had general obesity Degrees I–III and/or abdominal obesity. In all the patients there was conducted a various volume calculated excision of excessive and cicatricial–fibrous tissues and, in necessity, – alloplasty of hernial gates. Results. Overall parahernial excess of tissues in formatted hypogastic postoperative ventral hernias have had predominantly supraaponeurotical localization and metric characteristics, determined by the hernial dimensions, emphasis of adjacent lipid–containing layers and fibrous–cicatricious components. While performing of hernioabdominoplasty in such patients it is expedient to apply a combined tactics of standard aponeurotic hernioplasty and dermolipectomy/fibrolipectomy with abdominoplasty. This permits to lower essentially (up to 3%) the rate of the local complications development. Conclusion. The calculated beforehand hernioabdominoplasty constitutes the most rational principle of surgical treatment for hypogastric postoperative ventral hernias in patients, suffering obesity.