Abdominal binders after laparotomy: review of the literature and French survey of policies

[Physical Strain after Abdominal Surgery - Results of a Patient Survey]

INTRODUCTION

Incision hernias are common complications after abdominal surgery and affect the recommendations on postoperative physical strain, as it is thought that excessively early strain causes incisional hernias. However, there is no evidence to justify this. This study evaluates the effect of postoperative strain on the risk of incisional hernia.

MATERIALS AND METHODS

Patients with a laparoscopy (LS) or laparotomy (LT) were asked to complete a questionnaire on postoperative strain, complaints and quality of life. Patients with hernia surgery, or open abdomen therapy for complicated courses (Clavien-Dindo > III) were excluded.

RESULTS

393 patients completed the questionnaire (43.6%). 274 were LS and 128 LT. The incidence of incisional hernias was 5.2% (LS) and 18.0% (LT, p = 0.001). Incisional hernia patients were younger and more commonly males. 30.5% of incisional hernia patients did not return to normal physical strain postoperatively. Abdominal binders did not affect the hernia rate. The incisional hernia patients showed decreased quality of life scores in both mental and physical domains.

CONCLUSION

Early postoperative physical strain was not a risk factor for incisional hernia development in this study. However, prospective studies are needed to create necessary evidence to recommend earlier postoperative return to normal physical strain.

The effect of an abdominal binder on postoperative outcome after open incisional hernia repair in sublay technique: a multicenter, randomized pilot trial (ABIHR-II)

INTRODUCTION

Although the evidence is minimal, an abdominal binder is commonly prescribed after open incisional hernia repair (IHR) to reduce pain. This study aimed to investigate this common postoperative treatment.

METHODS

The ABIHR-II trial was a national prospective, randomized, multicenter non-AMG/MPG pilot study with two groups of patients (wearing an abdominal binder (AB) for 2 weeks during daytime vs. not wearing an AB following open IHR with the sublay technique). Patient enrollment took place from July 2020 to February 2022. The primary endpoint was pain at rest on the 14th postoperative day (POD) using the visual analog scale (VAS). The use of analgesics was not systematically recorded. Mixed-effects linear regression models were used.

RESULTS

A total of 51 individuals were recruited (25 women, 26 men; mean age 61.4 years; mean body mass index 30.65 kg/m2). The per-protocol analysis included 40 cases (AB group, n = 21; No-AB group, n = 19). Neither group showed a significant difference in terms of pain at rest, limited mobility, general well-being, and seroma formation and rate. Patients among the AB group had a significantly lower rate of surgical site infection (SSI) on the 14th POD (AB group 4.8% (n = 1) vs. No-AB group 27.8% (n = 5), p = 0.004).

CONCLUSION

Wearing an AB did not have an impact on pain and seroma formation rate but it may reduce the rate of postoperative SSI within the first 14 days after surgery. Further trials are mandatory to confirm these findings.

The Voodoo that We Do: Controversies in General Surgery

Incisional hernia remains a common complication following abdominal surgery, and its incidence can be reduced with standardized wound closure techniques. Robust evidence exists to support certain fascial closure methods, such as using a small bites, 4-to-1, continuous slow absorbable suture technique for elective midline laparotomies. On the other hand, there are other common surgical practices that lack quality data to support their routine use, such as abdominal binders, negative-pressure wound therapy, and reapproximation of subcutaneous tissue.

Recommendations on Postoperative Activities After Abdominal Operations and Incisional Hernia Repair-A National and International Survey

Background: There is no conclusive data on postoperative recommendations after abdominal and hernia surgery, and there is significant variation in the literature on that question. Thus, this study evaluates the status quo of recommendations of postoperative activity restriction after abdominal surgery. Materials and Methods: A national (German) and international survey of general surgeons on postoperative recommendations after abdominal and hernia surgery was pooled and analyzed. Results: A total of 74.6% recommended postoperative reduced activity for 2 weeks or less after laparoscopy. For midline laparotomy, 48.8% considered a reduced activity of 4 weeks or less to be sufficient. A majority from the national survey recommended more than 4 weeks instead (60.2%), whereas only 31.5% from the international survey did so (p = 0.000). In the pooled analysis, 258 of 450 (57.3%) rated 4 weeks or less suitable. However, the recommendations differed significantly between the surveys (4 weeks or less: a national survey, 47.1% vs. international survey, 64.6%; p = 0.000). Conclusion: There was substantial variation in the given recommendations. However, we found no evidence against immediate mobilization, reduced physical activity, and lifting for up to 2 weeks after laparoscopic surgery and for up to 4 weeks after open abdominal surgery and open incisional/ventral hernia repair in uncomplicated and standard cases. There might be individual and socioeconomic benefits to allow patients to return to their whole personal level of activity and work without putting them at risk of complications. Due to lack of evidence, both retrospective and prospective, controlled studies are in need to develop reliable recommendations.

The Effect of an Abdominal Binder on Postoperative Pain after Laparoscopic Incisional Hernia Repair-A Multicenter, Randomized Pilot Trial (ABIHR-I) of the Intraperitoneal Onlay-Mesh Technique

BACKGROUND

Incisional hernias with apertures measuring less than 7 cm can generally be treated adequately with the laparoscopic intraperitoneal onlay-mesh (IPOM) technique. The wearing of an abdominal binder after surgery is often recommended in order to promote wound healing and prevent recurrent herniation. We carried out a multicenter, randomized pilot trial to evaluate the utility of abdominal binders.

METHODS

The trial was conducted from May 2019 to December 2020. Persons treated for an incisional hernia with a laparoscopic IPOM procedure were included in the trial and randomized preoperatively into two equal-sized groups: the patients in one group wore an abdominal binder during the daytime for 14 days after surgery, while those in the other group wore no binder. The primary endpoint was pain at rest on postoperative days 1, 2, and 14, as measured on a visual analog scale. The secondary endpoints were overall subjective wellbeing, the rates of wound infection and recurrence, the complication rate, mobility, and the rate and size of postoperative wound seroma formation (on postoperative days 1, 2, and 14).

RESULTS

40 patients were included in the pilot trial. Three had to be excluded because of intraoperative conversion to an open surgical technique. The binder and no-binder groups (18 and 19 patients, respectively) did not differ in their biometric and perioperative data to any statistically significant extent. The patients in the binder group had significantly less postoperative pain (F [dfn, dfd] 4.44, 95% confidence interval [1; 35], p = 0.042).The patients in the binder group also had better overall subjective well-being and a higher rate of postoperative wound seroma formation than those in the no-binder group, but these differences did not reach statistical significance. The patients in the binder group had less limitation of mobility than those in the other group; this difference did not reach statistical significance, either.

CONCLUSION

A postoperatively worn abdominal binder may reduce pain after incisional hernia repair with the IPOM technique. The postoperative use of analgesic medication was not measured.

Failure of Abdominal Wall Closure: Prevention and Management

This article reviews evidence-based techniques for abdominal closure and management strategies when abdominal wall closures fail. In particular, optimal primary fascial closure techniques, the role of prophylactic mesh, considerations for combined hernia repair, closure techniques when the fascia cannot be closed primarily, and management approaches for fascial dehiscence are reviewed.

Effect of abdominal binder after laparoscopic cholecystectomy on enhanced recovery: a randomized controlled trialcontrolled trial

Purpose

The purpose of this randomized controlled trial was to compare the effects of abdominal binder after laparoscopic cholecystectomy.

Methods

From August to December 2020, 66 patients who were set to undergo cholecystectomy were selected for a prospective trial at Kangbuk Samsung Hospital, Seoul, Republic of Korea, and their clinical characteristics and postoperative surgical outcomes were evaluated. Among 66 patients, 33 patients belong to the abdominal binder group and the other 33 patients belong to the control group.

Results

The average hospital stay was 2.46 ± 1.29 days, and was not significantly different between the two groups. The average postoperative pain score (visual analogue scale, 0–10) 12, 24, and 48 hours after surgery were not significantly different. However, the degree of comfort score was significantly higher for the control group patients (2.56 vs. 3.33, p < 0.001). Time to the first ambulation, walking ability, return of bowel function, time to full diet resumption, and the numbers of analgesics and antiemetics administered were not significantly different between the two groups.

Conclusion

No postoperative recovery benefit and no reduction in hospital stay was found in patients who used an abdominal binder while undergoing laparoscopic cholecystectomy. Statistically, between the group that used the binder and the one that did not, no significant differences in surgical outcome nor postoperative outcome were observed. The only exception was that the degree of comfort score was significantly higher in the control group. Therefore, in terms of patient benefit and convenience, wearing an abdominal binder after laparoscopic cholecystectomy is not recommended.

The efficacy of abdominal binders in reducing postoperative pain and distress after cesarean delivery: A meta-analysis of randomized controlled trials

OBJECTIVE

To evaluate the efficacy of abdominal binders in reducing postoperative pain, patient distress and surgical postoperative sequelae after cesarean delivery (CD).

METHODS

A comprehensive search in electronic databases (MEDLINE, EMBASE, and Cochrane Central) was performed up to February 2021. Selection criteria included randomized clinical trials investigating the application or not of abdominal binder after CD. The primary outcome was postoperative pain, measured using the visual analog scale (VAS) pain score. Secondary outcomes were divided into short- and long-term postoperative outcomes, including patient distress, need for additional pain medications, time to mobilization, return to normal daily activities, surgical site infection, fascial dehiscence or incisional hernia, and rectus abdominis diastasis. The summary measures were reported as mean difference with 95 % confidence intervals (CI) using the random effects model of DerSimonian and Laird. An I² (Higgins I²) value of greater than 0% was used to identify heterogeneity.

RESULTS

Four RCTs involving 601 women were included for meta-analysis: 310 (51.6 %) were randomized to the abdominal binder and 291 (48.4 %) to no abdominal binder group. There was no statistically significant difference between the two groups for VAS score either at 24 h (MD -0.97, 95 % CI -2.23 to 0.30; p = 0.13) and at 48 h (MD -0.30, 95 % CI -0.71 to 0.11; p = 0.15). Conversely, there was a significant reduction in postoperative distress (SDS) both at 24 h (MD -2.23, 95 % CI -3.77 to -0.70; p = 0.004) and 48 h (MD -2.37, 95 % CI -3.86 to -0.87; p = 0.002).

CONCLUSION

The present meta-analysis shows that the use of abdominal binders after CD significantly reduces patient distress.

Effects of abdominal binders on postoperative pain and functional recovery: a systematic review and meta-analysis

OBJECTIVE

This study aimed to assess the effectiveness of abdominal binders (ABs) on postoperative pain and functional recovery in patients receiving abdominal surgery.

METHODS

The Pubmed, Embase, Cochrane Library, and PEDro databases were searched for clinical trials published up to November 30, 2019. Randomized controlled trials that compared the effects of wearing an AB to not wearing an AB in participants after abdominal surgery were included. The primary outcomes were pain, pulmonary function, and physical function, as assessed by the visual analog scale (VAS) score, a spirometry device, and the 6-min walk test (6MWT), respectively. The registration number of this review in PROSPERO is CRD42020165303.

RESULTS

Fourteen trials involving 1317 participants were included. Pooled estimates for the VAS score and the 6MWT showed significant differences between the AB group and the control group, especially on the fourth day following surgery (Mean Difference (MD) = -2.82, 95% Confidence Interval (CI) -3.41 to -2.22, P < 0.00001; MD = 50.97 m, 95% CI 39.99 to 61.95 m, P < 0.00001). However, no significant differences were found in pulmonary function (forced vital capacity (FVC): MD = 0.01, 95% CI -0.29 to -0.32, P = 0.94; forced expiratory volume during 1 s (FEV1): MD = -0.05; 95% CI -0.24 to 0.14; p = 0.63; FEV1/FVC: MD = 3.14, 95% CI -2.78 to 9.06, P = 0.30).

CONCLUSION

ABs probably improve postoperative pain and physical function, especially on the fourth day or more following abdominal surgery, but they have no effects on pulmonary function.

METHODS FOR ASSESSING THE RISKS OF COMPLICATIONS IN PATIENTS WITH HERNIAS OF THE ANTERIOR ABDOMINAL WALL. REVIEW

The work is based on the analysis of literature data devoted to the problem of assessing postoperative complications in patients with primary and incisional hernias of the anterior abdominal wall. The main purpose of this review is identifying existing methods for assessing local, general perioperative complications and determining of the most reliable prognostic scales and methods for assessing risk factors among the existing ones.

The first part of the article is devoted to the assessment of the general condition of patients with hernias of the anterior abdominal wall. The existing scales for assessing modifiable risk factors (MFR), methods of preventing complications, including abdominal bandage, are considered. The main risk factors were determined: CDC wound class, patient age, hernia size, smoking, diabetes, risk 3 and higher according to ASA.

In the second part, the assessment of risk factors for complications from the surgical site is considered. The problem of terminology standardization, the difference between surgical site infection (SSI), adverse surgical events (SSO) and surgical site occurrences requiring procedural interventions (SSOPI) is described. Scales for assessing the risks of perioperative complications are presented. The evolution of SSO assessment methods from a four level to a three level scale is described. The Russian experience in assessing the combination of MFR is presented.

The third part describes the importance of evaluating post traumatic stress disorder in patients as a risk factor for an unfavorable course of the postoperative period. The European EuraHS QoL Questionnaire, recommended for use in the European Hernia Registry, is presented. The section also highlights the relevance of the selection of patients with hernias in outpatient surgery and one day hospitals.

The main idea of developing modern methods for assessing complications after hernioplasty is a comprehensive assessment of the patient's individual profile before operations for primary and incisional hernias in different risk groups. Priority should be given to tailored specific electronic questionnaires.

The Clinical Effects of Abdominal Binder on Abdominal Surgery: A Meta-analysis

Objective. We conducted a meta-analysis to quantitatively evaluate the effects of abdominal binder in abdominal surgeries. Methods. Through literature retrieval in globally recognized databases (MEDLINE, EMBASE, and Cochrane Central), trials investigating the application of abdominal binder in abdominal surgeries were systematically reviewed. The main outcomes, namely, 6-minute walk test (6MWT), visual analog scale (VAS) pain score, and symptom distress scale (SDS) score, were pooled to make an overall estimation. I² index was calculated to identify heterogeneity, and sensitivity analysis was performed to validate the stability of main results and explore the source of heterogeneity. A funnel plot and Egger's test were applied to assess publication bias. Results. Ten randomized controlled trials consisting of 968 subjects were ultimately included for the pooled estimation. Abdominal binder significantly increased the distance of 6MWT with standard mean difference (SMD) of .555 (P < .001) and decreased the scores of VAS and SDS with SMD of -.979 (P < .001) and -.716 (P < .001), respectively. Despite of the significant heterogeneity indicated by I² index statistic, the results of sensitivity analysis revealed the reliability of the main conclusions. While we identified no obvious publication bias regarding 6MWT (Egger's test P = .321), it seemed that significant publication biases existed with respect to the estimation of VAS (P < .001) and SDS (P = .006). Conclusion. The current meta-analysis verified that abdominal binder efficiently promoted recovery after abdominal surgeries in terms of facilitating mobilization, alleviating pain, and reducing postoperative distress. More rigorously designed clinical trials with large sample size are expected to further elaborate its clinical value.

Evolving concepts in ventral hernia repair and physical therapy: prehabilitation, rehabilitation, and analogies to tendon reconstruction

PURPOSE

The abdominal wall and musculoskeletal tendons share many anatomic, physiologic, and functional characteristics. This review aims to highlight these similar characteristics and to present a rationale why the treatment principles of successful musculoskeletal tendon reconstruction, including principles of surgical technique and physical therapy, can be used in the treatment of complex abdominal wall reconstruction or ventral hernia repair.

METHODS

The MEDLINE/PubMed database was used to identify published literature relevant to the purpose of this review.

CONCLUSIONS

There are several anatomical and functional similarities between the linea alba and musculoskeletal tendons. Because of this reason, many of the surgical principles for musculoskeletal tendon repair and ventral hernia repair overlap. Distribution of tension is the main driving principle for both procedures. Suture material and configuration are chosen to maximize tension distribution among the tissue edges, as seen in the standard of care multistrand repairs for musculoskeletal tendons, as well as in the small bites for laparotomy technique described in the STITCH trial. Physical therapy is also one of the mainstays of tendon repair, but surprisingly, is not routine in ventral hernia repair. The evidence surrounding physical therapy prehabilitation and rehabilitation protocols in other disciplines is significant. This review challenges the fact that these protocols are not routinely implemented for ventral hernia repair, and presents the rationale and feasibility for the routine practice of physical therapy in ventral hernia repair.

Use of Abdominal Binders after a Major Abdominal Surgery: A Randomized Controlled Trial

Objective

To compare the effect of abdominal binder versus no binder after major abdominal surgery and cesarean section on various post-operative recovery parameters.

Materials and methods

This is a randomized controlled trial conducted at the Department of General Surgery and Obstetrics, Civil Hospital, Karachi, Pakistan. All those patients aged ≥18 years having abdominal surgery including elective and emergency abdominal surgery and cesarean sections with American Society of Anesthesiologists Class I-III were included in the study. Randomization was done using the sealed envelope method by the principal investigator. The intervention group wore an abdominal binder postoperatively while the control group did not use it. Mobilization and the pain status of both groups were evaluated on the first, fourth, and seventh days after surgery.

Results

Primary outcome variables were mobility, assessed via 6-minute walk test (6MWT) and postoperative pain, evaluated via visual analogue scale. There was no statistically significant difference in the 6MWT distance before (p = 0.278) and on postoperative day one of the surgery (p = 0.0762). However, the difference was significant on fourth (p < 0.001) and seventh day (p value < 0.001). With regards to the pain status, patients in the binder group reported significantly less postoperative pain on first, fourth, and seventh (p value < 0.001) day compared to the non-binder group.

Conclusion

The use of abdominal binder postoperatively significantly reduced pain and improved mobility in both obstetric and surgery patients.

Patient reported outcome following incisional hernia repair: A survey on 163 patients at two maximum care hospitals

Introduction

Incisional hernias of the abdominal wall are frequent complications after laparotomy (9–20%) and often need incisional hernia repair (IHR). In order to ensure wound healing and to therefore prevent postoperative short and long term morbidity carrying an abdominal binder (AB) and physical rest is frequently advised. However, there is a lack of evidence concerning clinical effects regarding these recommendations. Hence, we conducted a survey to analyze the patient reported outcome following IHR.

Methods

From December 2017 to May 2018, we conducted a survey among 270 patients who underwent open and laparoscopic IHR at two maximum care hospitals. They were interviewed about their type of operation, postoperative treatment, recommendations, and outcome.

Results

163 patients replied to the questionnaire. The average age was 63.2 ± 12 years. 74 patients were female and 89 were male. 32.6% of the patients reported an AB-induced immobility and 71.2% reported that the AB reduced pain after IHR. A prolonged period of physical rest and the use of an AB had no statistical significance on postoperative morbidity.

Conclusions

Due to our findings we assume that the AB may induce immobility and reduce postoperative pain. A prolonged period of physical rest and wearing an AB does not seem to have an impact on the postoperative outcome following IHR. Therefore, a shortened duration of physical rest and wearing an AB following IHR should be taken under consideration. To reveal more evidence on this topic further clinical trials are essential.

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The use of an abdominal binder may reduce pain following incisional hernia repair.

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On third of the questioned patients reported, that the AB induced immobility.

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A prolonged period of physical rest and carrying an abdominal binder may not prevent recurrences.

The use of adjuncts to reduce seroma in open incisional hernia repair: a systematic review

BACKGROUND

Seroma formation remains a common complication after an incisional hernia repair. The use of surgical drains is widespread, but evidence for their use and other adjuncts is limited. Our aim was to perform a systematic review of the literature on techniques used to reduce the incidence of post-operative seroma formation.

METHODS

A systematic search of PubMed and Embase databases was conducted using terms including "incisional hernia" and "seroma". All studies on adults undergoing open incisional hernia repair with at least one intervention designed to reduce seroma formation were included.

RESULTS

Of the 1093 studies identified, 9 met the inclusion criteria. Medical talc: one cohort study of 74 patients undergoing talc application following pre-peritoneal mesh placement found a significantly decreased rate of seroma formation of 20.8 versus 2.7% (p < 0.001), but a retrospective study including 21 patients with onlay mesh found an increased rate of 76% seroma formation from 9.5% (p = 0.001). Fibrin glue: one comparative study including 60 patients found a reduction in seroma formation from 53 to 10% (p = 0.003), whereas a retrospective study of 250 patients found no difference (11 vs. 4.9% p = 0.07). Negative pressure wound therapy: four retrospective studies including a total of 358 patients found no difference in seroma outcome. Others: one randomised study of 42 patients undergoing either suction drainage or "quilting" sutures found no difference in seroma formation.

CONCLUSIONS

There is currently insufficient quality evidence to recommend any of the investigated methods, some of which incur significant additional cost.

The effect of different types of abdominal binders on intra-abdominal pressure

[No Abstract Available].

Randomized controlled trial of abdominal binders for postoperative pain, distress, and blood loss after cesarean delivery

OBJECTIVE

To assess the effect of using abdominal binders on pain, distress, and postpartum hemorrhage after cesarean delivery.

METHODS

The present prospective randomized controlled trial enrolled patients undergoing non-emergency cesarean deliveries in Gonbad-e Kavus, Golestan Province, Iran, between January 22 and October 23, 2015. Patients were randomized in a 1:1 ratio by blocks of four or six to a control group or to use an abdominal binder after delivery; all patients received routine care. The primary outcomes were visual analog scale-assessed pain, symptom distress scale (SDS)-assessed distress, and hemoglobin and hematocrit levels. Participants and researchers were masked to treatment assignments until after cesarean delivery, and data analysis was unmasked; intention-to-treat analyses were performed.

RESULTS

There were 89 patients enrolled in each group, with no differences in baseline pain scores, SDS scores, and hemoglobin and hematocrit levels between the groups (all P>0.05). Pain and SDS scores were lower in the binder group at all post-baseline time points compared with the control group (all P<0.001). Hemoglobin and hematocrit levels were higher among patients who received binders 36 hours after baseline (both P<0.001). There was one patient who experienced hemorrhage in the binders group and one patient requested removal of their binder.

CONCLUSION

Patients who received abdominal binders reported less pain, lower SDS scores, and higher hemoglobin and hematocrit levels following cesarean delivery.

IRANIAN REGISTRY OF CLINICAL TRIALS

IRCT2015042521917N2.

The effect of different types of abdominal binders on intra-abdominal pressure

Objectives:

To investigate the effect of non-elastic/elastic abdominal binders on intra-vesical pressure (IVP), physiological functions, and clinical outcomes in laparotomy patients at the perioperative stage.

Methods:

This prospective study was conducted from May to October 2014 at the Trauma Surgery Department, Daping Hospital, Chongqing, China. Laparotomy patients were randomly divided into non-elastic abdominal binder group (28 patients), and elastic abdominal binder group (29 patients). Binders were applied for 14 days following the operation, or until discharge. Demographic information, Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores (prior to the operation, on the first day after operation, the day IVP measurement was stopped, and one day before discharge), and outcomes were recorded. The IVP was measured before the operation to postoperative day 7.

Results:

There were no significant differences in the demographic information, outcomes, SOFA or APACHE-II scores between the 2 groups. Initial out-of-bed mobilization occurred earlier in the elastic binder group (3.2 ± 2.0 versus 5.0 ± 3.7 days, p=0.028). A greater increase in IVP was observed in the non-elastic binder group than in the elastic binder group (2.9 ± 1.1 versus 1.1 ± 0.7 mm Hg, p=0.000).

Conclusion:

Elastic binders have relatively little effect on IVP and are more helpful at promoting postoperative recovery than non-elastic binders. Therefore, elastic binders are more suitable for clinical use.

Assessment of Abdominal Belts Impact on the Lungs Ventilation and Their Application in Early Physiotherapy after Major Abdominal Surgery - Prospective Trial

Early physiotherapy is an important part of the comprehensive treatment of patients after major abdominal surgery (MAS). Accelerated mobilization should be safe and requires the use of appropriate techniques. Most of the physiotherapists and surgeons recommends using abdominal belts. Opponents claim that belts have an adverse effect on lungs ventilation. The aim of the study was to determine the effect of abdominal belt on lung ventilation efficiency in the early period after MAS.

MATERIAL AND METHODS

The study involved 20 patients after MAS. Including 9 women and 11 men, aged between 40 to 90 years (x̅ 66.7). In the scheduled 7 patients and urgent 13. All of them were in the early period after surgery. Dynamic spirometry was performed twice in the postoperative period. For the first time wearing a belt, and then without the belt in the same group. Evaluated the forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF). For the analysis uses the Wilcoxon matched-pairs test and Spearman's rank correlations. P values <0.05 were considered significant.

RESULTS

The value of the ventilation indicators measured wearing abdominal belt were slightly lower than the values evaluated without the belt. The results are shown in percent predicted for age and gender, FEV wearing belt 52%, without belt 53%; FEV1 59% vs 61%; PEF 46% vs 51%. There were no statistically significant differences Conclusions. There were no significant negative influence of abdominal belt on lungs ventilation in early period after MAS. There was no correlations between age, body mass index and changes in ventilation indicators.