Clinical justification for preventive surgeries for abdominal wall hernias and cholelithiasis in cardiovascular surgical patients

Aim. Clinical justification for the necessity of sanitation surgeries for cholelithiasis and abdominal wall hernias in patients intended for heart valve surgery.

Methods. The study is based on the analysis of operative treatment results of 54 patients admitted to surgical department of Interregional clinical diagnostic center (Kazan) in 2007-2017 with cholelithiasis and abdominal wall hernias, who underwent laparoscopic cholecystectomy or herniotomy before or after an open heart surgery in cardiac surgical department No. 2 of the hospital. All patients were divided into two clinical groups. Group 1 consisted of 36 patients with a history of prosthetic heart valve, taking long-term warfarin. The comparison group included 18 patients, who at the first stage before cardiac surgery underwent sanitation surgeries for cholelithiasis and/or abdominal wall hernias. As part of the research, statistical analysis of intergroup differences was performed using non-parametric Mann-Whitney U-tests. Intergroup differences were determined by gender, age and type of cardiac and general surgical pathology.

Results. The analysis of the study groups showed that the average hospital stay among patients with long-term use of indirect anticoagulants was 15±1 day and varied from 12 to 19 days. The results indicate more than two-fold increase of an average hospital stay compared to patients, who underwent the same surgeries before cardiac interventions (р <0.05).

Conclusion. Before performing cardiac valve replacement with planned life-term or long-term use of anticoagulants with concomitant general surgical pathology (cholelithiasis, abdominal wall hernias with a tendency to strangulate), at the first stage, it is reasonable to perform so called sanitation surgeries aimed at eliminating abdominal pathology; such approach significantly decreases hospital stay of patients, and potentially contributes to lower probability of hemorrhagic complication incidences during the surgery and in the early post-operative period.