Current issues of surgical treatment of abdominal wallhernias in geriatric patients

doi:10.15406/mojgg.2020.05.00239

MOJ

eISSN: 2574-8130

Gerontology & Geriatrics

Editorial Volume 5 Issue 3

Current issues of surgical treatment of abdominal wallhernias in geriatric patients

Shaprinskyi VA, Vorovskiy OO

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National Pirogov Memorial Medical University, Vinnytsya, Ukraine

Correspondence: Vorovskiy OO. National Pirogov Memorial Medical University, Vinnytsya, Ukraine

Received: June 14, 2020 | Published: June 24, 2020

Citation: Shaprinskyi VA, Vorovskiy OO. Current issues of surgical treatment of abdominal wallhernias in geriatric patients. MOJ Gerontol Ger. 2020;5(3):103. DOI: 10.15406/mojgg.2020.05.00239

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Editorial

It was analyzed the surgical treatment results of 2217 (100%) patients, concerning with different defects of abdominal wall, who were operated during the period from 2002 to 2019. The patients were divided into two age groups: those, who are 60 years and older (the main group) - 1477 (66.6%) and patients of 40 to 59 years’ age (comparison group) - 740 (33.4%).

It has been defined the peculiarities of topographic - anatomical abdominal wall's changes in patients above 60 years old, which were being observed in the form of skin-fatty and muscular-aponeurotic layer's regrouping in 92% in patients and 100% in corpses. The criteria for such changes were: dilatation of thinning skin local areas with the emergence of stretch marks on more than one anatomical location, the obvious differences in thickness of subcutaneous adipose tissue throughout the whole anterior-lateral wall of abdomen, an increasing of width and decreasing in thickness of abdomen's white line, the thinning and fragmentation of fascia elements surface, muscles aponeurosis, the blood supply worseness of subcutaneous adipose tissue in lateral parts of abdominal wall and in dynamic crease, formed by skin-fatty "aprons".

It has been detected the genetically-determined disorders of connective tissue structure of patients with and without hernia, which were connected with the mutation of elastin gene g28197A> G in 20 exon (ELN) in 40.0% of patients from the main group and in 9.4% of the comparison group, which indicates for the infringement of synthesis of connective tissue structural proteins, first of all elastin. It has been also revealed the dynamics of increasing in number of connective tissue's mutational processes with aging.

It has been electron-microscopically found that the weakening of mechanical qualities (reduction of strength and elasticity) of dense fibrous tissue of patients with ventral hernias was typical due to a significant reduction in the number and destruction of elastic fibers. For elderly patients, in addition, there were strength disturbances due to the development of sclerotic, dystrophic, atrophic and in volutional changes in all structural elements of the fibrous tissue. The pathomophologic research of age-related changes in the abdominal wall muscles revealed significant degenerative changes, which intensity was directly proportional to age, the accumulation of the intracellular aging pigment - lipofuscin - around the nucleus, the segregation of myofibrils, which are located at the sizeable extent from each other, with the light zones of sarcoplasm, zones of homogeneous structures, fragmentation of myofibrils and pathology of muscle fibers: bundles of myofibrils with convoluted structures , myofibril splitting . The characteristic features of the research drugs are the cracks in the muscles' myofibril - "microgranules", as well as bar-like dark structures, located mainly in clusters (groups) along the myositis.

In the process of determination of prognosis criteria for development of post operative wound local inflammatory complications, we found the expected directions of the effect (sizeofherniad efects, presence of relapses, use of all oplastic methods "onlаy" and "inlаy") and it was also revealed that obesity increased the risk of local inflammatory complications in 11,9 times as compared with its absence, under condition of all other factors control. The method of "inlay"

Plastics increased the risk of post operative local inflammatory complications in 19.8 times as compared with the "sublay" method, with a control condition of all other factors. Initsturn, "onlay" plastics method increased the risk of post operative local inflammatory complications in 4.5 times ascompared with "inlay" method, with a control condition of allother factors. Confirmed on logistic regression basis, the prognosis model of post operative local inflammatory complicationss howed high efficiency, in particular, in sensitivity and specificity at different thresholds. Thus, atthreshold 0.2 level, 79.3% of sensitivity and 70.0% of specificity of prognosis were observed.

Complex surgical treatment of patients with abdominal wall defects with the help of differentiated approach to the developed all oplasty methods, postoperative complications prevention improved direct (reduce ment of postoperative complications up to 7.3% in the main group and upto 4.3% in the comparison group, in which there were no defects such as paracolosto my hernias and eventrations), as well as long-term treatment outcomes (reduce ment of disease relapses upto 0.5% in the main group and upto 0.7% in the comparison group) and mortality (upto 0.7% in the main group).