RESULTS OF FUNCTIONAL PERFORMANCE OF ABDOMINAL PRESS MUSCLES IN PATIENTS AFTER LAPAROSCOPIC CHOLECYSTECTOMY IN LONG-TERM PERIOD
Authors: Golod N. R. 
Published: July 2022

The Aim is to determine the level of functional ability of abdominal muscles in patients of different ages after LCH in the long-term rehabilitation period.

Materials and methods. Lovett's manual muscle testing (MMT) was performed on 113 patients after laparoscopic cholecystectomy (LCH), who were undergoing rehabilitation at the Morshyn kurort resort complex in 2020 and 2021. The average age of patients was 52,96±0,62 years. Patients were divided into 3 groups according to three age categories: group A - women aged 18 to 44 years (n = 14); group B - aged 45 to 59 years (n = 79); group C aged from 60 to 74 years (n = 20). Inclusion criteria: patients after LCH from 1 month to 1 year after surgery. Exclusion criteria: patients who have contraindications to testing: early postoperative period; pregnancy; severe circulatory failure, the presence of patients with neuropsychiatric pathology; peptic ulcer of the stomach and, or duodenum with bleeding, patients' refusal to participate in the study.

Methods. Evaluators were blinded during testing. Methods of synthesis, analysis and mathematical statistics. Indicators under study: functional ability of torso flexion and rotation muscles.

In order to assess the effect of LCH on the functional ability of the abdominal muscles, MMT was performed according to the Lovett method.

The results of the study. The results of the assessment of the functional ability of the abdominal muscles of patients after LCH in the long term indicate a decrease in the strength of the abdominal muscles in patients of three groups. Analyzing the results, it was found that the functional ability to bend the torso was the best in the youngest group A 2.86 ± 0.20 points. Slightly lower level of torso flexion was in group B 2.44 ± 0.07 points and the worst in the oldest group C - 2.20 ± 0.11 points. A statistically significant difference was found between the three groups in this indicator. In all three groups, the level of functional flexion of the abdominal muscles of patients after LCH was low. However, it was found that in three age groups there is an asymmetry in the level of muscle strength - in all patients the muscles that perform the function of torso rotation on the right are weaker than the muscles on the left side. In all three groups, there was a greater statistically significant difference between the strength of the functional ability of the abdominal muscles to rotate on the left than on the right. This result indicates that even minor surgery with minor damage to muscle fibers and fascia reduces the functional capacity of the abdominal muscles. LCH leads to an asymmetry in the strength of the external and internal oblique muscles of the abdominal press - a statistically significant decrease in the functional state of these muscles on the right compared with the strength of the muscles on the left in all age groups.

Conclusions. The low level of functional ability of the abdominal muscles of patients after LCH in the long term requires the inclusion in the protocols of rehabilitation physical therapy and occupational therapy. Accordingly, physical therapy and occupational therapy programs at this stage should include techniques to increase the strength of the abdominal muscles, due to the postponed surgery, recovery and improvement of motor capacity.