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Evaluation of Intraabdominal Presure changes after large Abdominal hernia Surgeries

100%
Pukacki F., Zieliński M., Grzeszczak M.
Polish Journal of Surgery
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2010
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vol. 82
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issue 5
259-266
EN
Occurrence of systemic complications after a large abdominal hernia operation depends on the increase of intraabdominal pressure (IAP). It is thus essential to device a preoperative method to predict IAP level changes in perioperative period.The aim of the study was evaluation of our own mathematical calculation of hernial sac volume in prognosis of intraabdominal pressure changes after abdominal wall reconstruction.Material and methods. Between January 2006 and November 2007 32 patients were operated because of a large abdominal hernia. Secondary hernias made up 68.8%, whereas primary hernias 31.3%. Mean patients' age was 67.5 years. Using our own method of mathematical calculation of hernial sac volume, the patients were divided into groups according to hernia size. Intraabdominal pressure values and their influence on respiratory, circulatory and excretory systems have been analyzed. The operation was conducted under intratracheal anesthesia. The abdominal wall plasty was carried out using a polypropylene mesh that has been placed in the prefascial retromuscular space.Results. No perioperative deaths were observed. The highest mean IAP increase occurred after hernial ring closure, whereas the highest mean abdominal perfusion pressure (APP) drop was observed in the first 24 hours after the operation. There was observed a positive correlation between hernial sac volume (HSV) and IAP values and a negative one between HSV and APP value. There was observed a decrease of diuresis, saturation, blood pressure and an increase of urea and creatinine in the first 24 hours after the operation.Conclusions. A non-invasive hernial sac volume measurement helps to predict postoperative IAP growth and thus development of general complications. Pressure-free operations seem to be safe in terms of preventing post-operative intraabdominal pressure growth.
2
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Evaluation of the Levels of Metalloproteinsase-2 in Patients with Abdominal Aneurysm and Abdominal Hernias

88%
Antoszewska M.
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vol. 85
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issue 5
271-278
EN
Abdominal aortic aneurysms and abdominal hernias become an important health problems of our times. Abdominal aortic aneurysm and its rupture is one of the most dangerous fact in vascular surgery. There are some theories pointing to a multifactoral genesis of these kinds of diseases, all of them assume the attenuation of abdominal fascia and abdominal aortic wall. The density and continuity of these structures depend on collagen and elastic fibers structure. Reducing the strengthof the fibersmaybedue to changes in the extracellular matrix (ECM) by the proteolytic enzymes-matrix metalloproteinases (MMPs) that degrade extracellular matrix proteins. These enzymes play an important role in the development of many disease: malignant tumors (colon, breast, lung, pancreas), cardiovascular disease (myocardial infarction, ischemia-reperfusion injury), connective tissue diseases (Ehler-Danlos Syndrome, Marfan’s Syndrome), complications of diabetes (retinopathy, nephropathy). One of the most important is matrix metalloproteinase-2 (MMP-2). The aim of the study was an estimation of the MMP-2 blood levels in patients with abdominal aortic aneurysm and primary abdominal hernia, and in patients with only abdominal aortic aneurysm. Material and methods. The study involved 88 patients aged 42 to 89 years, including 75 men and 13 women. Patients were divided into two groups: patients with abdominal aortic aneurysm and primary abdominal hernia (45 persons, representing 51.1% of all group) and patients with only abdominal aortic aneurysm (43 persons, representing 48,9% of all group). Results. It was a statistically significant increase in MMP-2 blood levels in patients with abdominal aortic aneurysm and primary abdominal hernia compared to patients with only abdominal aortic aneurysm. It was a statistically significant increase in the prevalence of POCHP in patients with only abdominal aortic aneurysm compared to patients with abdominal aortic aneurysm and primary abdominal hernia. Conclusions. Statistically significant higher MMP-2 blood levels in patients with abdominal aortic aneurysm and primary abdominal hernia seems shows that this enzyme plays a role in the pathogenesis of primary abdominal hernias. The observed distribution of MMP-2 blood levels in patients with abdominal aortic aneurysm and primary abdominal hernia may raise the conclusion that this enzyme determines the presence of multi-organ failure of the connective tissue - the patients with only abdominal aortic aneurysm had significantly lower MMP-2 blood levels.
3
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Anticoagulants as a Risk Factor in Patients Operated on for Abdominal Hernia

75%
Piątek B., Piwnik M., Podgórski M., Strzelczyk J.
Polish Journal of Surgery
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2015
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vol. 86
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issue 6
263-267
EN
The aim of the study was to determine whether patients treated with anticoagulants in the perioperative period are at higher risk of developing bleeding complications. Material and methods. Medical records of patients operated for abdominal hernia were analysed. Data concerning demographic characteristic of a group, type of hernia, comorbidities, preoperative anticoagulation therapy and complications were collected. Association of applied anticoagulation therapy with the time of drainage, the amount of drained discharge and the length of hospitalisation was evaluated. Results. Analysed group consisted of 186 patients. Thirty seven patients were treated with different schemes of anticoagulant therapy before the the surgery. Patients treated with triple anticoagulation therapy (acetylsalicylic acid, low-molecular weight heparin, vitamin K antagonists) had significantly longer time of drainage in comparison to patients treated according to other schemes (p<0.05). The amount of drained discharge and time of hospitalisation did not differ significantly. Neither comorbidities nor the administration of low-molecular weight heparin did not affect the analysed parameters. Conclusions. Patients operated on abdominal hernia, who were treated with triple anticoagulation therapy in peri-operative period, require significantly longer drainage of the wound what can result in prolonged hospitalisation
4
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Causes for abdominal hernia in patients after hernioplasty

75%
Krawczyk-Horocch B., Mraz M., Mraz M., Markocka-Mączka K.
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PL
Obserwacji i badaniom poddano grupę chorych operowanych z powodu przepuklin. Materił analizowano pod ką-tem występowania przepuklin i ich związku z nadwagą, wiekiem, trybem zycia, poziomem wykształcenia, miejscem zamieszkania i cięzką pracą fizyczną pacjentów. W pracy poddano takze analizie związek między występowaniem powikłań pooperacyjnych a otyłością, rodzajem znieczulenia i sposobem wykonania zabiegu operacyjnego oraz przedstawiono metody usprawniania przed- i pooperacyjnego stosowane u pacjentów poddawanych plastyce przepuklin. Badaniem objęto grupę 50 pacjentów Kliniki Chirurgii Przewodu Pokarmowego i Chirurgii Ogólnej Akademii Medycznej we Wrocławiu leczonych operacyjnie z powodu przepuklin brzusznych. Grupę tę stanowiło 16 kobiet i 34 męzczyzn w wieku od 23 do 80 lat. Wyniki badań odnotowywano w specjalnie przygotowanej karcie badania zawierającej informacje ogólne i związane z tematyką badań. Analiza wyników ujawniła, ze występująca nadwaga u badanych chorych mogła mieć istotny wpływ na powstanie przepuklin brzusznych oraz ze na rozwój przepuklin, poza otyłością, mogą mieć wpływ czynniki pośrednie, takie jak wiek, tryb zycia, cięzka praca fizyczna i poziom wykształcenia. Wykazano takze, ze stosowany rodzaj znieczulenia, lokalizacja i wielkość przepukliny oraz związa-ny z tym sposób wykonania zabiegu operacyjnego mogą mieć wpływ na powstawanie powikłań pooperacyjnych, szczególnie w zakresie układu oddechowego oraz ze współistniejące choroby zwiększają prawdopodobieństwo wystąpienia powikłań pooperacyjnych.
EN
A group of patients after hernioplasty was observed and examined in this study. The research material was analysed in terms of hernias occurrence and their relationship with overweight, age, lifestyle, education level, place of residence and hard physical work. The authors also studied the relationship between post-operative complication and obesity, type of anaesthesia and the operative technique and presented methods of pre- and post-operative rehabilitation for patients subjected to hernioplasty. This study covered a group of 50 patients of the Clinic of Alimentary Tract Surgery and General Surgery of Medical University in Wroclaw, who had been operated for abdominal hernias. The group included 16 women and 34 men, aged 23 to 80 years. The results of examinations were recorded on a specially prepared examination card. The analysis of findings revealed that overweight might have a significant impact on development of abdominal hernias and that other factors such as age, lifestyle, hard physical work and education level may influence development of hernias. It was also shown that the type of anaesthesia, location and size of hernia and the operative technique applied may have impact on occurrence of post-operative complications especially in the region of the respiratory system and that concomitant diseases increase the probability of post-operative complications.
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