Prevention of Complications of Incisional Hernia Repair: Current Problem State (Review)

Parshakov, A.A.; Гаврилов, В А; Самарцев, В А

doi:10.17691/stm2018.10.2.21

Cited by 10 publications

(1 citation statement)

References 41 publications

(48 reference statements)

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“…Проблема послеоперационных вентральных грыж, несмотря на развитие малоинвазивных технологий остается актуальной [1][2][3]. Послеоперационные вентральные грыжи (ПОВГ) занимают второе место после паховых грыж, составляя от 10 до 30,7% от общего числа грыж брюшной стенки [4][5][6].…”

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Experimental study of method for suturing laparotomy wound with mesh thread

Inyutin¹,

Федосеев²,

Muraviev³

et al. 2021

HMJ

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Aim. Development of an alternative to preventive prosthetics method of primary closure of a laparotomy wound, superior in morphological and physical properties to the method of closure with traditional suture materials. Materials and Methods. The team of authors developed a method of laparorrhaphy, where the white line of the abdomen is sutured first with strengthening sutures with a mesh thread in places of highest tension, and then a continuous suture is applied. The effectiveness of this variant of wound closure was studied in a cadaver experiment and on tissues of laboratory pigs. In the course of the cadaver experiment, in 10 corpses of both genders a midline laparotomy was performed with suturing of the white line of the abdomen by the above-described technique with creation of intra-abdominal hypertension up to 140 mm Hg using a device designed for this. In the course of the experiment on animals, in 8 pigs under general anesthesia upper-median laparotomy up to the peritoneum 10-12 cm long was performed. The white line of the abdomen was sutured using the above-described technique with a mesh thread in the lower part of the wound. The upper part of the wound was closed with a checkerwise-reinforcing suture. At the second stage of the experiment, on the 14th day from the moment of the first operation, all animals were reoperated. A macroscopic assessment of the wound process was performed. Then the sutured sections of the aponeurosis were excised and subjected to strain gauge examination on an electronic dynamometer. For comparison, a similar study was carried out on an intact aponeurosis. Results. In the course of studies carried out on corpses, no cases of suture failure with the underlying created intra-abdominal hypertension were noted. The tensometry of the studied sutures proved that the initial strength of the reinforcing suture made of «mesh thread» was higher than that of one checker wise-reinforcing suture (tCt=27.053±0.745; p<0.01) and two nodal sutures (tCt=-18.834±0.582; p<0.01). On the 14th day, the strength of checkerwise-reinforcing suture was also lower than that of the reinforcing suture with a «mesh thread» (tCt=11.198±1.499; p<0.01). Conclusions. The method of suturing with «mesh thread» provides greater strength compared to other types of sutures due to good conditions for even distribution of the load on all suture stitches and the formation of a strong scar in the future.

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Experimental study of method for suturing laparotomy wound with mesh thread

Inyutin¹,

Федосеев²,

Muraviev³

et al. 2021

HMJ

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General views on treatment technologies for patients with incisional ventral hernia

Лукоянычев

Izmailov

Емельянов

et al. 2021

Issled. prakt. med. (Print)

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Nowadays, the problem of surgical treatment of incisional ventral hernia (IVH) still remains significant. According to the statistical data, the number of patients with postoperative ventral hernias has increased by more than 9 times over the past 25 years. Experts offer many solutions to this problem every year and the surgeon have to find the best method of postoperative rehabilitation in the flow of information. Academic research databases Google Scholar, CyberLeninka and others were used to search for the relevant literature. The following conclusions were drawn from this review. The etiology of IVH is multifactorial. There is no generally accepted evidence-based gradation of risk factors. There is no unified system for selecting the method of hernia repair of the anterior abdominal wall in patients with IVH. The choice of allotransplant material and the method of hernia repair are often individual. The value of the critical level of intraabdominal pressure have not been specified, however, all authors agree that its monitoring should become routine. The sublay technique remains the "gold standard" of plastic surgery by aponeurotic flap, inlay should be used when sublay is impossible to perform. Onlay should be used as a reserve method. In some situations, combinations of techniques are required. More and more laparoscopy is being introduced in the treatment of IVH as an assistance and in therapy. The introduction of new methods of hernia repair based on the uncontrolled separation of the anatomical structures of the abdominal wall imposes special requirements on surgical technology: plastic material, instrumental and technical support, wound closure and pharmacological support, especially in conditions of increased intra-abdominal pressure and tissue tension. We can use medication of pyrimidine’s row (xymedon) for a better implantation of the mesh implant and to increase the resistance of local tissues.

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Experimental study on an alternative to suturing the laparotomy wound with a mesh thread

Федосеев

Владимирович²,

Cherdantseva

et al. 2021

I.P. Pavlov Russian Medical Biological Herald

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BACKGROUND: Incisional ventral hernias (IVH) in abdominal surgery remain relevant because the frequency of their formation after laparotomy reaches 10%30.7%. AIM: This study aimed to develop a method for the primary closure of a laparotomy wound via mesh endoprosthesis, which is superior to laparorrhaphy with traditional suture materials in terms of morphophysical properties. MATERIALS AND METHODS: Laparorrhaphy with a mesh thread was developed (Patent for invention RUS No 2714439 02/14/2020) as an alternative to preventive prosthetics with narrow indications to avoid herniation. An experimental work was conducted to investigate the wound process in the suture area on days 14 and 60 and determine the effectiveness and safety of the proposed method. RESULTS: Video laparoscopy data showed that no cases of adhesions were observed between the internal organs and the area of laparorrhaphy on days 14 and 60 of the postoperative period. Defects in the area of the application of sutures on the aponeurosis of the white line were absent. In the wound, the mesh thread fully integrated into the regenerating tissue, including at the site of the knot. The tissue also grew through the meshed cells. On day 14, the strength of the regenerating tissue with the sutured mesh thread was greater than that sutured without it (11.198 1.499, p 0.01). This finding was confirmed by the larger area of granulations and fibrosis in cases of mesh suture than that of the checkerwise-reinforcing suture, suture with a mesh thread, and suture with a strip of mesh endoprosthesis. Another peculiarity of the connective tissue newly formed in the area of the mesh endoprosthesis in the form of the mesh thread was that collagen fibrils were arranged concentrically. By contrast, the mesh strip had collagen fibrils arranged in a longitudinal orientation parallel to the endoprosthesis. On day 60 of the experiment, all the series showed signs of maturation of the connective tissue in the form of the predomination of fibrils in cellular elements and their compaction. The area of fibrosis and granulations still prevailed in cases of the mesh suture, where neocollagenogenesis in the cells of the endoprosthesis was more pronounced than that after the application of a reinforcing suture, a mesh thread, and a strip of mesh endoprosthesis. CONCLUSION: The absence of wound complications and negative impact on the surrounding tissues indicated the safety of using the mesh suture. The strengthened characteristics associated with the peculiarities of the wound process showed that the mesh suture was effective in preventing the occurrence of postoperative hernia. Therefore, this method could be used in clinical practice.

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Prevention of Complications of Incisional Hernia Repair: Current Problem State (Review)

Cited by 10 publications

References 41 publications

Experimental study of method for suturing laparotomy wound with mesh thread

Experimental study of method for suturing laparotomy wound with mesh thread

General views on treatment technologies for patients with incisional ventral hernia

Experimental study on an alternative to suturing the laparotomy wound with a mesh thread

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