Implementation of an enhanced recovery protocol for open and laparoscopic repair of ventral hernia
Keywordspostoperative ventral hernia, open hernioplasty, laparoscopic hernioplasty
AbstractIn the light of introduction of the concept of rapid recovery and the use of miniinvasive methods of treatment of postoperative ventral hernias, laparoscopic herniology attracts more and more attention of practical surgeons. This is due to virtually no wound complications, a reduction of the duration surgery and inpatient stay, which greatly improves social and labor adaptation. Objective. Evaluate the benefits of laparoscopic hernioplasty over the open one in the light of the concept of rapid recovery of ERAS – enhanced recovery after surgery. Materials and methods. For a comparative evaluation in the period from 2015 to 2017, 81 patients with postoperative ventral hernias were examined and surgically treated. According to the methods of hernioplasty, all patients were divided into two groups. The group 1 consisted of 38 (46.91 %) persons who underwent laparoscopic hernioplasty. The group 2 consisted of 43 (53.09 %) persons who underwent "open" allohernioplasty. The multimodal patient management program provided for common elements for both groups aimed at rapid recovery in the postoperative period. Results. The average duration of "open" hernioplasty was (143±25) min, laparoscopic – (98±14) min. The laparoscopic technique of hernioplasty does not require routine drainage of the abdominal cavity. When open allohernioplasty drainage was performed in 72 (69.20 %) cases. 5–6 hours after the surgery, using the "sublay" technique 66 (63.50 %), patients were able to take the vertical position and activate the motor activity within the hospital ward, the rest – during the first day. The postoperative stay in the stanionarium in the group of patients after the "open" hernioplasty was on average (7.98±1.36) days, after the laparoscopic operation – (2.63±1.28) days, respectively. Conclusions. Endovideo-surgical methods for the elimination of primary and postoperative ventral hernias are effective, safe, provide early mobilization of patients and their rapid labor and social adaptation due to a significant smaller number of early and late complications. Restrictions in the use of these treatments are considered to be hernia of a gigantic size, especially postoperative with pronounced joint process and severe concomitant diseases, in which the increase in intraabdominal pressure will be critical and will negatively affect the immediate results of surgical treatment.
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