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13МЕДИЦИНСКИЕ НАУКИ
FACTORS OF DEVELOPMENT OF VENTRAL HERNIAS IN PATIENTS WITH OBESITY (LITERATURE REVIEW)
Azzamov J.A.
Azzamov Jasur Azamatovich - Student, MEDICAL FACULTY,
SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: the article presents an overview of the scientific literature devoted to the pathogenesis of hernias of various localizations in patients suffering from obesity. Different views of scientists on their origin have been described, an attempt has been made to systematize them in terms of preventive measures.
Keywords: obesity, body mass index, hernia, treatment, abdominoplasty.
Treatment of patients with a hernia of the anterior abdominal wall remains an urgent problem of surgery. This is due to the fact that the number of dumplings during the last decades remains practically unchanged, amounting to about 5% of the total population of the planet [4, 12], and the proportion of postoperative hernias in the structure of external abdominal hernias is constantly growing, reaching now 20-30% of all operations on the organs of the abdominal cavity. One of the reasons for the occurrence of postoperative ventral hernias (PVH) is the presence of obesity. Patients with obesity of varying degrees make up 50 to 70% of all patients with PVH. The frequency of recurrence of PVH in obese patients can reach 64%, and according to individual reports, 92% [2, 18]. The use of alloplasty reduces the frequency of recurrence of ventral hernias to 0-10% [1, 7, 19]. In 2008, WHO recognized obesity as an epidemic of the 21st century and proposed the development of a program for its prevention. Assessment of obesity and overweight is based on the body mass index (BMI), which is calculated by the formula: body weight (kg) is divided by the growth amount, squared (m2). This indicator is not used to diagnose obesity in persons over 65, athletes and pregnant women [8, 13, 16]. Obesity is at the same time a biological and social problem, as it negatively affects working capacity and longevity. Excessive fat accumulation is an integral part of the overall cardiovascular risk, which increases the likelihood of the development and progression of cardiovascular diseases (CVD) and type 2 diabetes mellitus (DM 2), which are leading among the causes of mortality in many countries [6, 14]. Obesity is a multifactorial disease. Genetic predisposition, exocrine causes, changes in the hormonal and neurological conditions lead to a violation of eating behavior, all kinds of metabolism and energy imbalance. Studies show that intestinal microflora also causes overweight and obesity in some people [13, 17]. Over the past decades, people's way of life has changed. Economic growth, technological progress and transformations in the social sphere led to the fact that the nature of nutrition and daily physical activity became insufficient in relation to food consumed. It has been established that the deposition of fats is unlimited and can reach tens of kilograms [7, 11]. In patients with obesity in addition to therapeutic diseases (hypertension, coronary heart disease, early atherosclerosis of vessels, type 2 diabetes, hormonal disorders, etc.) that increase the risk of premature death, there is an increased risk of ventral hernia formation, both primary and after various interventions on the organs of the abdominal cavity [2, 10]. This is facilitated by a higher intra-abdominal pressure compared to patients without obesity. This is confirmed by an increased risk of recurrent hernia recurrence, which is 2.5 times higher than in patients without obesity [13]. The peculiarity of hernias in patients with obesity is that over the hernial sac a dermal fatty apron is formed, reaching a large size, with the development in it of trophic disorders in the skin and subcutaneous tissue, which causes a high incidence of postoperative local complications. Moreover, the skin-fat apron is also
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considered as an independent cause of the formation of primary and recurrent PVH [5, 13]. E.N. Kologrivova with co-workers. (2005) showed that one of the reasons for the frequent formation of hernias in patients with obesity are pronounced immune disorders. In dandruffers with concomitant obesity, cellular immunity disorders consist in significantly lower CD3 +, CD16 + lymphocyte counts, as well as in the violation of the CD4 + / CD8 + ratio compared to the control group and patients without obesity [9, 13, 16]. In all patients with large postoperative hernias, overweight and obesity occur in 70-90% of cases [9, 20]. According to some authors obesity is more often observed in patients with ventral primary and recurrent hernias, whose frequency varies from 31.1% to 37%. An important factor in hernia formation is the nature of fat distribution. One of the factors predisposing to the development of primary and recurrent hernias is a violation of the dynamic balance of the muscles of the anterior abdominal wall [15, 19]. According to several authors, morbid obesity is revealed in more than 60% of patients with hernias of different locations. There is a pathogenetic relationship between morbid obesity and hernial disease, which is promoted by the following factors: dystrophic changes in the tissues of the anterior abdominal wall, flabbiness of muscles and aponeurosis; overstretch of the tissues of the anterior abdominal wall by a dermal-subcutaneous apron; hormonal imbalance and secondary hyperaldosteronism, aggravating dystrophy of the tissues of the anterior abdominal wall; immune deficiency; disturbance of dynamic balance of the muscles of the anterior abdominal wall; elevated abdominal pressure [3, 19]. Consequently, in patients with obesity hernias, the pathogenesis of the development of the disease has its own characteristics, which should also affect the technique of performing operations. However, in the literature this issue is not given due attention. So, access to hernia in patients with obesity is not well substantiated, the question of the necessity of removing the skin-subcutaneous apron and performing abdominoplasty is not settled; the choice of the method of plastic surgery of the hernial gates is decidedly ambiguous; issues of prevention and treatment of postoperative complications are insufficiently developed. These and many other issues of treating patients with hernias, obese, require further study and development.
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