reventive Endoprosthetics in Patients with Morbid Obesity

Introduction. Patients with morbid obesity (BMI ≥ 35 kg/m²) are at high risk of developing postoperative ventral hernias due to increased intra-abdominal pressure, anatomical features and comorbidities. The main cause of hernias are postoperative complications, including seromas, hematomas, suppurations and eventrations, as well as factors increasing intra-abdominal pressure, such as cough, constipation, physical activity, etc. Aim. To reduce the incidence of postoperative ventral hernias and complications in patients with morbid obesity. Materials and methods. A method of endoprosthetics by laparotomy for preventing the formation of postoperative ventral hernias in high-risk patients has been developed and implemented into clinical practice. This method involves placing a synthetic implant (polypropylene) into the retromuscular space with fixation to the aponeurosis of internal oblique abdominal muscles. Results. The technical result of using this method involves the formation of a dense connective tissue scar and a reduction in the incidence of postoperative ventral hernias due to minimized risk of migration and rejection of the synthetic implant. Discussion. According to the presented data, the incidence of postoperative ventral hernias in the compared groups statistically significantly decreased from 30.7 to 5.2% (p = 0.039). The differences in the development of seromas and hematomas in the main and control groups are statistically insignificant (>0.05) amounting to 21.05 and 19.2%; seromas and hematomas recovered spontaneously without invasive interventions. Conclusion. For reducing the risk of postoperative ventral hernias, patients with morbid obesity are recommended to undergo preventive endoprosthetics during laparotomy surgery. The advantage of this method involves the reduction of postoperative complications, including the occurrence of chronic pain syndrome, and the improvement of the patients’ quality of life.

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