Correction of intra-abdominal hypertension in patients with surgical pathology in case of morbid obesity

Abstract

Sustained increase of intra-abdominal pressure (IAP) in patients with surgical pathology of the abdominal cavity can lead to disorders in the systems of a body, leading to the onset of abdominal compartment syndrome (ACS)[1]. A special risk group for the occurrence of ACS is patients with morbid obesity (MO)[2]. For the correction of intra-abdominal hypertension (IAH) a lot of techniques have been proposed [3]. In patients with MO, the most effective method for correction of IAH is laparolifting (LL)[4]. However, all known methods of LL are used with the use of an endolift, requiring special conditions (sterility, the presence of an anesthetist, etc.). Objective: to improve the results of treatment of the IAH. Methods. We have proposed a method for correction of IAH by applying an exolift, which is a special polyethylene sleeve 15 cm wide (50 microns thick), wrapped around the body of the patient at the level of the umbilical region. A polyethylene tube is inserted under the sleeve and connected to an electric aspirator. The space between the sleeve and the skin is sealed with adhesive tapes, after creating a negative pressure between the skin and the sleeve at a level of 1.15-0.20 bar, using two lifting ropes, fixed with one end to the sleeve on the anterior-lateral surfaces of the abdomen, and on the other hand to the holding mechanism of the bed. Then a conduction of a traction sleeve, and with it the anterior abdominal wall, is perfomed to normalize IAP. For the period from 2013 to 2016 the proposed method was used in 23 patients with surgical pathology of the abdominal cavity on the background of MO. Men were 13 people (56.5%), women - 10 (43.5%). The average age of patients was 52.3 + 1.2 years. Results. The use of the proposed method of correction of IAH using LL in the composition of conservative measures to combat the IAH in patients with surgical pathology of the abdominal cavity allowed to reduce the incidence of systemic complications by 37.1%, local complications - by 19.3%, and the total mortality - by 9, 8%. Conclusions. 1. Application of the proposed method for correction of IAH using LL can effectively reduce IAP in patients with surgical pathology of the abdominal cavity and avoid the development of ACP. 2. The method is non-invasive, convenient, easy enough and quick to use, can be done in the ward where the patient is, which makes it possible to apply it widely in medical practice. Literature 1. Rogers WK, Garcia L. Intraabdominal Hypertension, Abdominal Compartment Syndrome, and the Open Abdomen. Chest. 2018 Jan;153(1):238-250. doi: 10.1016/j.chest.2017.07.023. Epub 2017 Aug 2. PMID: 28780148.2. Sosa G, Gandham N, Landeras V, Calimag AP, Lerma E. Abdominal compartment syndrome. Dis Mon. 2019 Jan;65(1):5-19. doi: 10.1016/j.disamonth.2018.04.003. Epub 2018 Nov 17. PMID: 30454823. 3. De Laet IE, Malbrain MLNG, De Waele JJ. A Clinician's Guide to Management of Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients. Crit Care. 2020 Mar 24;24(1):97. doi: 10.1186/s13054-020-2782-1. PMID: 32204721; PMCID: PMC7092484. 4. Khitar’Yan AG, Miziev IA, Provotorov ME, Veliev KS, Glumov EE, Kovalev SA, Abramyants MK, Khubiev ST. APPLICATION OF LAPAROSCOPIC LIFTING SYSTEMS IN PATIENTS WITH HIGH CARDIORESPIRATORY RISK. Vestn Khir Im I I Grek. 2016;175(4):62-6. English, Russian. PMID: 30457274.