Surgical correction of the posterior abdominal wall using the Tar technique

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Introduction. A. A. Niyazov and co-authors (2020) in their study claim that each year the frequency of hernias is more than 20 million cases, and postoperative ventral hernias are found in 22% of all hernias of the anterior abdominal wall [1].
Speaking about patients at risk, it should be noted that E. A. Rustamov and co-authors (2019), based on the results of their research, hypothesized that women are more at risk of postoperative hernia, which is associated with the reproductive function of women (cesarean delivery), and after menopause with menstrual cycle disorders. This study also claims that patients over the age of 45 have impaired collagen metabolism, concomitant pathologies (for example, diabetes mellitus, obesity and cardiovascular diseases) and weakening of the muscles of the anterior abdominal wall, which together increases the risk of postoperative hernia [2, 3, 4].
I. V. Klyushkin and co-authors (2020) report that postoperative ventral hernias can occur after any surgical intervention on the abdominal cavity, and therefore the issue of selecting a suitable surgical aid that will not only minimize postoperative complications, but also improve the patient's quality of life is relevant [5, 6, 7].
The most common and relevant method at present is the method of back separation plastics. This method was introduced into clinical practice in 2012-2013 by a group of American scientists led by Y. W. Novitsky. A variant of posterior separation plastic surgery was described. N. K. Tarasova and co-authors (2021) highlighted the advantages of this method based on clinical observations: the ability to operate on large hernias by reconstructing them, minimizes the risk of developing compartment syndrome, PE, relapses, and most importantly death [8, 9, 10].
The aim of the work was to evaluate the results of surgical interventions (posterior separation plastic surgery, TAR method) for postoperative hernias.
Materials and methods of research. In the course of the work, a statistical analysis of patients' indicators was carried out before surgery and in the postoperative period. The use of drug prophylaxis in the preoperative and postoperative periods of each patient was evaluated for a more accurate data analysis. Surgical interventions were performed on the basis of the surgical department of GBUZ GKB No. 7 in Tver. To evaluate the surgical technique, the medical history data of 12 operated patients for postoperative hernias were used, aged 46 to 74 years - 7 male patients (58.3%) and 5 female patients (41.7%) (significance level p=0.415).
The results of the study. In the course of this study, it was revealed that more than 90% of patients have a BMI >25.
All patients had concomitant diseases, it should be assumed that the presence of concomitant diseases is associated with the age of the patients. Based on the statistical analysis, 8 patients (66.7%) have a history of hypertension of stages 2 and 3 (significance level p=0.103).
It should be noted that 7 patients (58.3%) (significance level p=0.415) had a history of stomach diseases, in the form of chronic atrophic gastritis – 6 patients (85.7%) and gastric ulcer – 1 patient (14.3%) (significance level p=0.008), This was proved by an esophagogastroduodenoscopy performed before surgery.
According to the case histories, 8 patients (66.7%) (significance level p=0.103) underwent surgery on the anterior abdominal wall more than 2 times, and 4 patients (33.3%) had a history of hemicolectomy with removal and then subsequent closure of the colostomy, and 5 patients (41.7%) history of sigmoid colon resection with removal and subsequent closure of the sigmostome (significance level p=0.638).
In the course of this study, the incidence of complications in the form of PE was 0% (significance level p=0.638), which is an indicator of properly performed prevention. In the postoperative period, PE was prevented not only by elastic bandaging of the lower extremities, but also by prescribing anticoagulants.
During the analysis of the performed operations, it was revealed that the blood loss of patients ranged from 35 ml to 150 ml, which is an insignificant amount of lost blood. In turn, the TAR technique shows a fairly low injury rate and high vascular safety during surgery using the TAR technique.
All but one of the patients were transferred to the surgical department for further treatment after surgery. 1 patient (8.3%) (significance level p<0.001) was transferred to the OAIR department to restore heart rhythm, but the patient was transferred to the surgical department a day later.
The following antibiotics were used: ceftriaxone – 9 patients (75%), ciprofloxacin – 3 patients (25%) (significance level p=0.015).
All operated patients underwent medical anesthesia. NSAIDs were used as an analgesic – paracetamol in 11 patients (91.7%), ketorolac in 1 patient (8.3%). None of the patients needed the use of narcotic analgesics, which indicates low nerve injury as a result of TAR-method surgery.
No deaths were detected among the operated individuals. In 11 patients (91.7%), surgery was performed without surgical complications, with a characteristic increasing positive dynamics in the postoperative period.
Conclusions. The death rate based on the analyzed surgical interventions is 0%, the incidence of complications in the form of PE is 0%, complications were detected in only 1 patient out of 12 (8.3%), which positively characterizes the quality of the intervention and indicates a detailed study of the medical history of each patient.
It should be noted that the TAR method in this study is used in the city clinical hospital No. 7, where patients were operated on as planned according to compulsory medical insurance, and therefore it can be assumed that surgeons are highly qualified and equipped with sufficient equipment to perform this surgical intervention in a medical institution.

About the authors

Daniela Alexandrovna Dogaru

Tver State Medical University

Email: ammorozovv@gmail.com
ORCID iD: 0009-0009-4267-5771
SPIN-code: 4051-4595
Russian Federation, 170100, Russia, Tver, Sovetskaya str., 4

Artem Mikhailovich Morozov

Tver State Medical University

Author for correspondence.
Email: ammorozovv@gmail.com
ORCID iD: 0000-0003-4213-5379
SPIN-code: 6815-9332

PhD., Associate Professor of the Department of General Surgery

Russian Federation, 170100, Russia, Tver, Sovetskaya str., 4

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