Primary bariatric operation as preoperative preparation stage for patients with incisional hernia with concomitant morbid obesity

<p>Obesity is considered as the main risk factor of incisional hernia especially in patients with morbid obesity. Among factors of relapse risk are the next ones: considerable intra-abdominal hypertension, big number of wound complications, technical (intraoperative) difficulties of hernioplasty caused by obesity. Conservative treatment of the morbid obesity has no effect.</p><p><strong>Methods</strong><strong>:</strong> There was carried out an analysis of treatment of patients with incisional hernia with concomitant morbid obesity (MO). They underwent bariatric operation before hernioplasty which was postponed till decrease and stabilization of body mass. Immediate and remote results were analyzed.</p><p><strong>Results: </strong>3o patients who underwent bariatric operation (BO) before hernioplasty took part in the research. Body mass index (BMI) was</p><p> ≥40 kg/m² (25 women, their mean BMI was 48,5±8,7 kg/m², intra-abdominal pressure (IAP) was 2,36±0,09 kPa. 19(63,3%) of patients underwent bending of stomach (BS), 11 (36,7 %) – shunting of stomach (SS). Three patients had complications: two seromas and pneumonia. The relapse of hernia was noticed in one patient (3,3 %). The mean loss of weight in 2 years after BS was 34,8±6,7 kg, after SS – 57,3±3,7 kg, intra-abdominal pressure – 1,31±0,08 kPa. The general number of preoperative concomitant diseases was 73. After two-year observation respiratory and metabolic disorders were completely compensated in 50 % of patients and considerably improved in 38 %.</p><p><strong>Conclusions: </strong>The use of phased tactics of treatment leads to the most favorable results. BO gives a possibility to improve the physical state of patient and prepare him for herniaplasty<em></em>