ABSTRACT
The review is devoted to the treatment of ventral hernias in patients with morbid obesity. This issue is important due to significant number of such patients and no unambiguous clinical recommendations. The advantages of simultaneous surgery (with bariatric intervention) are obvious, i.e. lower risk of postoperative hernia incarceration and no need for re-hospitalization with another intervention. High risk of bariatric population makes it necessary to minimize surgery time and surgical trauma. A staged approach with reducing body weight surgically or conservatively before hernia repair is often chosen. Hernia repair should be performed using laparoscopic or robotic techniques with obligatory use of mesh implants. Panniculectomy or abdominoplasty as the main surgery is a valid option. Currently, it is necessary to develop clear criteria for selecting patients with morbid obesity for staged and simultaneous treatment of ventral hernias.
Subject(s)
Abdominoplasty , Hernia, Ventral , Incisional Hernia , Obesity, Morbid , Humans , Obesity, Morbid/complications , Obesity, Morbid/diagnosis , Obesity, Morbid/surgery , Hernia, Ventral/diagnosis , Hernia, Ventral/etiology , Hernia, Ventral/surgery , Abdominoplasty/adverse effects , Herniorrhaphy/adverse effectsABSTRACT
Case report is devoted to successful pancreatectomy for cancer of terminal part of common bile duct in a patient with heterotaxy syndrome. The main difficulties during dissection of pancreaticoduodenal complex arose due to anatomical disorientation and the lack of standard topographic and anatomical landmarks. Preoperative computed tomography with assessment of visceral vessel anatomy is essential in all patients with biliopancreaticoduodenal tumors. If heterotaxy syndrome is suspected, additional examination is required to detect other potential abnormalities and prepare for unusual situation.
Subject(s)
Common Bile Duct Neoplasms , Heterotaxy Syndrome , Pancreaticoduodenectomy , Common Bile Duct/blood supply , Common Bile Duct/diagnostic imaging , Common Bile Duct/surgery , Common Bile Duct Neoplasms/complications , Common Bile Duct Neoplasms/diagnostic imaging , Common Bile Duct Neoplasms/surgery , Dissection , Duodenum/blood supply , Duodenum/diagnostic imaging , Duodenum/surgery , Heterotaxy Syndrome/complications , Heterotaxy Syndrome/diagnosis , Heterotaxy Syndrome/diagnostic imaging , Humans , Pancreas/blood supply , Pancreas/diagnostic imaging , Pancreas/surgery , Preoperative Care , Splanchnic Circulation , Tomography, X-Ray ComputedABSTRACT
Surgical treatment of post-traumatic right-sided phrenic hernia is associated with certain technical difficulties due to topographic and anatomical features. Morbid obesity combined with diabetes mellitus type II is one of the main factors complicating any surgical thoracic or abdominal surgery and further rehabilitation. We report simultaneous surgery for complicated post-traumatic right-sided phrenic hernia in a patient with morbid obesity and diabetes mellitus type II. Surgical correction of giant phrenic hernia facilitated further effective treatment of morbid obesity and concomitant diabetes mellitus type II.
Subject(s)
Diabetes Mellitus, Type 2 , Herniorrhaphy , Obesity, Morbid , Diabetes Mellitus, Type 2/complications , Hernia/complications , Humans , Obesity, Morbid/complications , Treatment OutcomeABSTRACT
OBJECTIVE: To analyze an effectiveness of laparoscopic surgery with simultaneous abdominoplasty in patients with superficial abdominal obesity. MATERIAL AND METHODS: Laparoscopic abdominal, retroperitoneal and pelvic surgery with simultaneous abdominoplasty was performed in 25 patients with body mass index >40 kg/m2. RESULTS: Surgery time and intraoperative blood loss were significantly higher after simultaneous surgery (p<0.05). However, these differences did not influence postoperative period. Duration of analgesic therapy, activation of patients and length of hospital-stay, as well as overall postoperative morbidity were similar in both groups (p>0.05). Simultaneous abdominoplasty resulted significantly better quality of life according to almost all parameters (p<0.05). CONCLUSION: According to certain indications, abdominoplasty is advisable as the first stage of simultaneous surgery in patients with large subcutaneous fat apron after bariatric surgery or in those with primary superficial abdominal obesity. The positive aspects of abdominoplasty are simplification of laparoscopic stage, reduced intra-abdominal pressure in postoperative period, excellent and good aesthetic effect and improved quality of life.
