Experimental substantiation of the original technique of hernioplasty of ventral hernias of lateral localization

Introduction. The aim of the study was a morphological and biomechanical assessment of the degree of changes in the target structures of the lateral parts of the anterior abdominal wall during hernia and to determine the possibilities of surgical correction of the identified changes.

   Materials and methods of research. The work was based on anatomical studies of 36 human corpses. Biomechanical parameters of native, scar-modified and reinforced fascial structures of the anterior abdominal wall with a skeleton thread according to the original surgical technique were studied at the ISS-500 stand using the Scaima ZF-500 force sensor.

   Results. The target structures (weak points) of the lateral parts of the anterior abdominal wall involved in the formation of hernias should be considered: paravertebral, subcostal and lateral fascial nodes (paired). Degenerative processes of fascial-muscular tissues in the area of hernial gates lead to a decrease in their biomechanical parameters compared to native drugs by more than two times, which leads to a relapse of the disease after hernioplasty. When performing hernioplasty in an original way, the tensile strength of tissues in the area of hernial defect plasty increases by 44,2 %, and the modulus of elasticity by 49,1 % compared to such indicators in a herniator.

   Conclusion. The proposed technique of strengthening the edges of the hernial gate with two frame threads when fixing the mesh graft increases the ability of tissues to withstand the increasing intra-abdominal pressure after surgery, which prevents the threat of relapse of the disease.

1. Grigoryan R. A. Abdominal surgery. M.: OOO «Medicinskoe informacionnoe agentstvo», 2006, Vol. 1, pp. 107. (In Russian)

2. Ivanova T. E., Zhidkov S. A. Postoperative abdominal hernias: method. Recommendations. Minsk: BSMU, 2007, 20 p. (In Russian)

3. Popov A. Y., Petrovskiy A. N., Gubish A. V. and others. Results of restoration of the anterior abdominal wall in postoperative ventral hernias using mesh implants. Hirurgia. Journal im. N. I. Pirogova, 2020, № 3, рр. 35–42. (In Russian)

4. Parker S. G., Wood C. P., Butterworth J. W., et al. A systematic methodological review of reported perioperative variables, postoperative outcomes and hernia recurrence from randomised controlled trials of elective ventral hernia repair: clear definitions and standardised datasets are needed. Hernia, 2018, № 22, pp. 215–226. (In Russian)

5. Ermolov A. S., Blagovestnov D. A., Alekseev A. K., et al. Surgical treatment of patients with large and giant postoperative ventral hernias. Hirurgia. Journal im. N. I. Pirogova, 2019, № 9, рр. 38–43. (In Russian)

6. Fedoseev A. V., Rybachkov V. V., Trushin S. N., Lebedev S. N., Inyutin A. S. Preventive abdominal wall replacement in risk groups for post-operative ventral hernias. Journal im. N. I. Pirogova, 2019, № 1, рр. 32–36. (In Russian)

7. Bueno-Lledó, J., Torregrosa-Gallud, A., Sala-Hernandez, A., Carbonell-Tatay, F., Pastor, P. G., Diana, S. B., & Hernández, J. I. Predictors of mesh infection and explantation after abdominal wall hernia repair. The American Journal of Surgery, 2017, № 213 (1), pp. 50–57.

8. Chandra R., Jacobson, R., Poirier J., et al. Successful non-operative management of intraabdominal hypertension and abdominal compartment syndrome after complex ventral hernia repair: a case series. The American Journal of Surgery, 2018, № 216 (4), pp. 819–823.

9. Pawlak M., Tulloh B., de Beaux, A. Current trends in hernia surgery in NHS England. The Annals of The Royal College of Surgeons of England, 2017, № 102 (1), pp. 25–27.

10. Dietz U., Menzel S., Lock, J. et al. The treatment of incisional hernia. Deutsches Ärzteblatt International, 2018, № 115 (3), pp. 31–37.

11. On approval of the Rules for the Transfer of unclaimed body, organs and tissues of a Deceased Person for use in medical, scientific and educational purposes, as well as the use of unclaimed body, organs and tissues of a deceased person for these purposes. Decree of the Government of the Russian Federation dated 21. 07. 2012 № 750 (ed. dated 17. 12. 2016) https://t.me/publicationpravogovru. Accessed 21. 09. 2022. (In Russian).

12. Method for the study of fascia and cellular spaces: Patent № 2271740 Russian Federation, A61B 5/103 (2006. 01), № 2004115696: application 25. 05. 2004: publ. 20. 03. 2006; applicant Tatianchenko V. K., Sarkisyan V. A., Andreev E. V., Chubaryan K. A. (In Russian).

13. Method of non-tensioning plastic surgery of recurrent ventral hernias: Patent № 2739679 Russian Federation, A61B 17/00 (2020. 08), A61F 2/0063 (2020. 08), A61L 17/04 (2020. 08), No. 2020126179; application 03. 08. 2020; publ. 28. 12. 2020. Korobka V. L., Shapovalov A. M., Korobka A. V., Dabliz R. O. (In Russian)