Choice of Alternative Method of Surgical Intervention in Abdominal Rectus Diastasis with Concomitant Midline Hernias

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INTRODUCTION: To date, no consensus has been achieved on the most appropriate surgical method for the treatment of abdominal rectus diastasis concomitant with midline hernias.

AIM: Study of the results of three original methods of surgical treatment of patients with abdominal rectus diastasis concomitant with midline hernias.

MATERIALS AND METHODS: The results of treatment of 74 patients have been analyzed. The patients were divided into three comparable groups: in the first group (n = 25), repair with local tissues with formation of aponeurotic duplication was performed, in the second group (n = 24), autodermal de-epithelialized graft was used, in the third group (n = 25) — mesh sub-lay implants. The following parameters were evaluated: duration of narcotic analgesia in the postoperative period, period of activation of patients, periods of inpatient treatment and results on Clavien-Dindo and EuraHSQoL scales. The follow-up period was from 1 to 10 years after surgery.

RESULTS: The period of postoperative use of narcotic analgesics was 1.08 ± 0.38 days in the first group, 0.98 ± 0.33 days in the second group, 2.13 ± 0.93 days in the third group. The period of activation was 3.00 ± 1.53 days in the first group, 0.89 ± 0.36 days in the second group, 1.5 ± 0.48 days in the third group; the duration of inpatient treatment was 9.24 ± 1.88 bed-days, 6.34 ± 3.04 bed-days and 8.36 ± 2.14 bed-days, respectively. Postoperative complications in the first group were CDI class 6, CDII class 3, in the second group CDI class 1, in the third group CDI class 6, CDII class 3. At 12 months after the operation, painful sensations and functional discomfort on EuraHSQoL scale were absent in the second group, in the first and third groups, limitations in physical activity were noted (р ≤ 0.05; differences between the first and third groups were statistically insignificant, p ≥ 0.05). There were no statistically significant differences in the cosmetic discomfort between the groups (p ≥ 0.05).

CONCLUSION: A safer and more effective method of repair of the anterior abdominal wall in patients with concomitant abdominal rectus diastasis and midline hernias is plastic surgery with application of de-epithelialized autodermal graft.

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作者简介

Andrey Topchiev

Astrakhan State Medical University

编辑信件的主要联系方式.
Email: andrei_093@bk.ru
ORCID iD: 0000-0001-8402-1009
SPIN 代码: 8144-9917

MD, Cand. Sci. (Med.)

俄罗斯联邦, Astrakhan

Andrey Fedoseyev

Ryazan State Medical University

Email: colobud@yandex.ru
ORCID iD: 0000-0002-6941-1997
SPIN 代码: 6522-1989

MD, Dr. Sci. (Med.), Professor

俄罗斯联邦, Ryazan

Mikhail Topchiyev

Astrakhan State Medical University

Email: topchievma@mail.ru
ORCID iD: 0000-0002-9162-7831
SPIN 代码: 2187-1230

MD, Dr. Sci. (Med.), Professor

俄罗斯联邦, Astrakhan

Andrey Protasov

Peoples' Friendship University of Russia

Email: andrei.protasov@rambler.ru
ORCID iD: 0000-0001-5439-9262
SPIN 代码: 3126-7423

MD, Dr. Sci. (Med.), Professor

俄罗斯联邦, Moscow

Dmitry Parshin

Astrakhan State Medical University

Email: parshin.doc@gmail.com
ORCID iD: 0000-0002-1050-7716
SPIN 代码: 8248-1975

MD, Dr. Sci. (Med.)

俄罗斯联邦, Astrakhan

Akhmed Nurmagomedov

Astrakhan State Medical University

Email: ahmed05.87@mail.ru
ORCID iD: 0000-0003-4813-2961
SPIN 代码: 1900-2833

MD, Cand. Sci. (Med.)

俄罗斯联邦, Astrakhan

Ildyrym Mukhtarov

Astrakhan State Medical University

Email: ildyrym_m@mail.ru
ORCID iD: 0000-0002-7929-0519
SPIN 代码: 7808-6269
俄罗斯联邦, Astrakhan

Rasul Sherkulov

Astrakhan State Medical University

Email: rasul.sherkulov.00@bk.ru
ORCID iD: 0009-0006-2499-2819
俄罗斯联邦, Astrakhan

参考

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2. Fig. 1. Scheme of surgery (A) and view of the surgical field (B) of patients of the first study group (comments in the text).

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3. Fig. 2. Scheme of surgery (A) and view of the surgical field (B) of patients of the second study group (comments in the text).

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4. Fig. 3. Pain sensations on EuraHSQoL scale in the groups before surgical intervention and at 12 months.

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5. Fig. 4. Physical activity on EuraHSQoL scale in study groups before surgical intervention and at 12 months.

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6. Fig. 5. Satisfaction with the appearance on EuraHSQoL scale in study groups before surgical intervention and at 12 months.

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