The place of fast-track technologies in patients with strangulated abdominal hernias without hollow organ resection

Abstract

The aim of the study is to substantiate the possibilities and analyze the results of fast-track technologies in patients with strangulated abdominal hernias without hollow organ resection. Materials and methods. The work was based on the result analysis of surgical treatment for 691 patients with strangulated abdominal hernias without resection of a hollow organ, who were divided into 2 groups depending on the specifics of diagnostic and therapeutic tactics, and into 2 subgroups depending on the localization of strangulated hernias. For patients of group 2, in contrast to group 1, the following diagnostic tactics: mandatory and justified laparoscopic intra-abdominal assessment of the strangulated organ condition; mandatory physicochemical intraoperative assessment of the hernial fluid condition; mandatory intraoperative instrumental assessment of the strangulated organ condition; as well as the therapeutic tactics: mandatory use of a comprehensive fast-track program; expansion of indications for laparoscopic surgery were used. The clinical and diagnostic algorithms included laboratory, instrumental and biochemical methods of examination. Results. It has been found that the proposed diagnostic and therapeutic tactics in group 2 patients with strangulated abdominal hernias without hollow organ resection, in contrast to group 1 patients, allowed to increase the number of laparoscopic operations by 51.15 % as well as the number of surgical interventions using fast-track technology by 51.21 %. This was accompanied by a decrease in complications according to the Clavien-Dindo scale from 83 (24.56 %) in group 1 patients to 39 (11.05 %) in group 2 patients. In addition, in group 2 patients, in contrast to group 1, a decrease in the acute pain severity in the early postoperative period and chronic pain according to the sf-IPQ in the late postoperative period has been revealed. Conclusions. The indication expansion for fast-track technologies in group 2 patients with strangulated abdominal hernias without hollow organ resection has allowed using these procedures in 238 (67.23 %) cases, while there were only 54 (16.02 %) such cases in group 1 patients. The proposed diagnostic and therapeutic tactics in group 2 patients with strangulated abdominal hernias without hollow organ resection, in contrast to group 1 patients, have enabled an increase in the number of laparoscopic operations from 16.27 % in group 1 patients to 67.42 % in group 2, which was accompanied by a decrease in postoperative complications according to the Clavien-Dindo scale from 24.56 % to 11.05 %.