A method of preparing patients for intraabdom inal hypertension before surgery for large postoperative ventral hernias

The aim of the study was to develop a non-invasive technique for the prevention of intra-abdominal hypertension in patients undergoing surgery for large postoperative hernias. Materials and methods. The prospective, direct, non-randomized study involved 50 patients who underwent surgery to repair ventral hernias of various localization and sizes and were hospitalized from 2020 to 2025 at Surgical Department No. 2 of the Republican Clinical Hospital in Nalchik. The main group (n = 21) underwent gradual tightening of the abdominal brace with a decrease in the functional vital capacity of the muscles by 10% and 20% under the control of spirometry parameters. The control group (n = 29) wore a bandage in a free mode. The average age of the patients was 51.9 ± 4.6 years. The follow-up period was 3 months. In the postoperative period, intra-abdominal pressure was measured daily using an Abdo–Preshe unometer, and spirometry was performed. The QoR-15 questionnaire was used to assess the quality of life of patients. The SPSS Statistics 17.0 software was used for statistical data processing when comparing study groups. The results of the study. As a result of preoperative preparation according to the developed methodology, spirometry indicators in the main group recovered by day 16. On day 1 of the postoperative period, the main and control groups showed an increase in intra–abdominal pressure by comparable amounts (the experimental group — 18.5 ± 6.5 mm of water, the control group — 16.1 ± 7.1 mm of water; at p = 0.112). However, the degree of respiratory disorders in the control group was signifi cantly higher. When assessing the quality of life, statistically signifi cant diff erences were noted between the groups in terms of categories of issues characterizing physical comfort, the need for psychological support and emotional state. The number of points scored by the participants of the main group was statistically signifi cantly higher than in the control group. At the same time, the number of points was comparable in the groups of questions characterizing pain and physical independence. Conclusion. The technique of preoperative preparation of the patient for the occurrence of intraabdominal hypertension using an abdominal bandage under the control of spirometry accelerates the postoperative recovery of patients, reducing the degree of respiratory disorders against the background of increased intra-abdominal pressure. In addition, this technique increases the patient's stress tolerance and reduces physical discomfort after surgery.

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