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

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.

Influence of polypropylene mesh on local and systemic production of cytokines during thoracoplasty in experiment

Introduction. The question of the body's immune reactivity when using mesh implants for plastic surgery of the chest frame remains not fully understood.Aims. The effect of the polypropylene mesh endoprosthesis "Surgipro" on systemic and local cytokine production after reconstruction of the chest frame was evaluated.Materials and methods. The work was performed on male Wistar rats weighing 250 50 grams (n=21). The main group consisted of rats with musculo-aponeurotic plasty (n=9), the comparison group consisted of animals that underwent chest plasty after removal of the posterior segment of the IV rib measuring 1.0 cm and overlapping over the mesh (n=9). Healthy rats without surgery served as control (n=3). The animals were taken out of the experiment on days 1, 10 and 30 after the operation. Determination of cytokines TNF-, IFN- and IL-10 in the blood serum and biopsy of the postoperative scar was performed by the method of enzyme-linked immunosorbent assay.Results. It was found that in the experiment, the plastic of the chest frame affects the systemic and local production of cytokines TNF-, IFN- and IL-10. A more intense increase in serum and local anti-inflammatory cytokines was recorded with the use of the implant (p˃0.05). At the same time, the production of anti-inflammatory IL-10 was recorded at values below the control (p˃0.05).Conclusions. The conducted experimental study revealed that the use of a mesh endoprosthesis in the restoration of a defect in the thoracic frame causes more pronounced systemic and local production of cytokines TNF-, IFN- and reduces the production of IL-10.

Immediate and long-term results of laparoscopic hernioplasty in inguinal hernias with and without mesh endoprosthesis fixation

The objective of this study was to conduct comparative analysis of the immediate and long-term results of laparoscopic inguinal hernioplasty performed with and without fixation of the mesh endoprosthesis.Methods and materials. The base group included 77 patients who underwent laparoscopic inguinal hernioplasty without fixation of the mesh by herniostepler. The control group included 76 patients who underwent laparoscopic inguinal hernioplasty with mesh fixation by herniostepler. To assess the postoperative period, the following criteria were studied: the severity of postoperative pain on a Visual Analog Scale; postoperative complications on the Clavien-Dindo scale; an early recurrence of inguinal hernias determined by ultrasound.Results. In both groups, the severity of postoperative complications did not exceed grade I. Among the entire list of complications, there were observed: pain in the area of surgery, an increase in body temperature above 38.5 °C, acute urinary retention, swelling and hematoma of the scrotum, seroma. There were no cases of conversion, intraoperative damage to internal organs and vascular structures. Complications in both groups do not differ significantly and do not depend on the method of laparoscopic inguinal hernioplasty: with fixation of the endoprosthesis by herniostepler or without fixation. The level of pain in the early postoperative period in patients operated by laparoscopic inguinal hernioplasty with mesh fixation was significantly higher. During control examinations of patients on the day after surgery, at the time of discharge and 6 months after surgery, no cases of dislocation of mesh endoprosthesis and relapse of inguinal hernia were detected.Conclusion. The obtained data indicate the effectiveness of laparoscopic hernioplasty in inguinal hernias with polypropylene mesh without fixing with herniostepler.

THE USE OF MESH ENDOPROSTHESIS IN SURGICAL TREATMENT OF VENTRAL HERNIA

Surgical treatment of patients with ventral hernias remains an urgent problem in abdominal surgery. More than 20 million operations are performed annually in the world for hernias. The urgency and complexity of the problem is based on the fact that inadequately performed surgery leads to a recurrence of the disease in 14-54% of cases. The aim of the work is to study the results of surgical treatment of patients with ventral hernias using mesh endoprostheses. The results of a retrospective analysis of 437 hernioplasty performed with hernias of various localizations for the period from 2010 to 2014 were used. Patients were classified by hernia localization and divided into groups depending on the methods of alloplasty. The duration of observation of patients operated by using polypropylene mesh ranged from 6 month to 3 years. An analysis of the complications that developed after alloplasty of the inguinal, postoperative, umbilical hernias and hernias of the linea alba was carried out. Our clinical experience confirms that the operation of Liechtenstein is rightly considered to be the “gold standart” for the treatment of inguinal hernias. However, the use of polypropylene mesh in the treatment of inguinal hernias leads to the development of postsurgical wound complications. Placed next to the polypropylene mesh peritoneum flap plays the role of internal drainage, prevents the development of seromas in the wound. The use of a new inguinal alloplasty technique reduced the number of postoperative complications. Also, the best immediate and long-term results are obtained by alloplasty using a sublay method. In patients with postoperative hernias operated by sublay method, no recurrences were observed and they showed the best quality of life.

The results of preperitoneal inguinal hernioplasty without fixation of the mesh endoprosthesis in the experiment.

The purpose of the study is experimental development of preperitoneal inguinal hernioplasty with synthetic mesh, according assessment of the need of its fixation to the tissues. Materials and methods. An inguinal hernia was simulated on human cadaveric material. The study used 27 male corpses. Two inguinal hernias were modeled on one corpse: on one side - indirect, on the other - direct. A polypropylene mesh (standard density, 15 x 15 cm) was placed in the preperitoneal space. The endoprosthesis was impacted from the side of the abdominal cavity by a special designed device. The effect of a peak intra-abdominal pressure of 200 mm Hg was simulated. The degree of displacement of the reticular endoprosthesis into the inguinal canal was estimated at the moment of peak pressure on it from inside the abdominal cavity. For a simulated indirect inguinal hernia, two variants of the technique were considered: with fixation of the endoprosthesis to the underlying tissues and without fixation. For the modulated direct inguinal hernia, the following options were considered: non-fixative, with fixation at one point to the pubis and with plasty of the transverse fascia. Results. When modeling preperitoneal plasty of a direct inguinal hernia, there is a pronounced displacement of the endoprosthesis into the inguinal canal with a non-fixing plasty, unlike the method with transverse fascia plasty or fixation to the pubis. In indirect inguinal hernia, there was no significant displacement of the endoprosthesis in both considered variants. Conclusions. According to the obtained results, conclusions were drawn on the need for additional plasty of the transverse fascia or fixation of the endoprosthesis at a single point in a direct inguinal hernia. With indirect inguinal hernia in the experiment, no significant difference in the displacement of the mesh endoprosthesis into the inguinal canal was obtained with and without fixation.