The article analyzes the results of electromyography of the abdominal muscles in 189 patients with median postoperative hernia of the anterior abdominal wall of different sizes before and after the combined methods of hernioplasty, including considering the level of connective tissue failure. In the preoperative period, electromyography was performed in 69 (36,6%), after combined hernioplasty, 120 (63,4%) patients. The patients were divided into a group of 161 (85,1%) patients with clinically significant or histologically confirmed connective tissue insufficiency and into a group of 28 (14,9%) patients without it. The distribution of patients in the examination groups was carried out using an original method of assessing the degree of deviation of collagen fibers from the projection of the Langer lines in microscopic specimens of the skin areas excised during the operation and based on the results of a retrospective analysis of case histories with determination of the intraoperative adhesions of the adhesions in the abdominal cavity or hernial sac. In the formed groups, we studied the amplitude, frequency, front and area of electromyograms obtained from the direct and lateral muscles of the anterior abdominal wall. It was found that in patients with median postoperative hernias, mesenchymal dysplasia was the main reason for the decrease in functional activity and the imbalance of forces between the direct and lateral abdominal muscles. Optimal restoration of electroactivity of the abdominal muscles after combined hernioplasty occurred among patients without clinically significant connective tissue insufficiency. When reaching a giant postoperative hernia of gigantic size in patients with a clinically significant level of connective tissue dysplasia, the functioning of the abdominal muscles decreased by 26%, and in patients without it only by 15%. The pathology of collagen in skin grafts excised during surgery was detected in 91,5% of patients with mid-incisional hernias.

Relevance. Recently, much attention has been paid to the study of the role of various risk factors in the pathogenesis of herniation along the midline of the abdomen. The question of their interrelation with another equally important predictor of herniogenesis - connective tissue insufficiency remains understudied. The aim of the present study is to investigate the severity of connective tissue dysplasia and peculiarities of its interaction with other risk factors in different variants of midline abdominal herniotransformation. Materials and Methods. The examined group included 150 (89.2%) patients with postoperative median hernias of various sizes and 18 (10.8%) patients with primary hernias of the white line of the abdomen. In 12 (8%) cases, relapses of postoperative hernial protrusions were noted. In 12 (10.5 %) cases, relapses of postoperative hernial protrusions were noted. The surveyed group included 109 (64.8 %) women and 59 (35.2 %) men. Risk factors for median herniogenesis were evaluated in the opposite sense relative to the severity of connective tissue pathology. Results and Discussion. We evaluated the risk factors of median herniogenesis in the opposite value and direction with regard to the severity of connective tissue pathology in the observation groups. It was found out that the leading role in herniotransformation of the medial abdominal line belongs to the suppuration of postoperative medial wounds, relaparotomy and heavy physical load with the role efficiency of 66.6 %, 56.2 % and 54.5 % respectively. The lowest level of connective tissue dysplasia was observed in the groups where the risk factors of median herniogenesis were the age of patients, the presence of relaparotomy in the history and heavy physical activity. Only in the observation group, where pregnancy and childbirth in the anamnesis were the predictors, the patients with white line hernias had less severe connective tissue insufficiency by 27,9 % in comparison with the patients with postoperative median hernias. In patients with recurrent midline hernias in all risk factors, the severity of connective tissue dysplasia always reached the maximum score. Conclusion. At any predictor of hernia formation or their combined effect, the severity of connective tissue dysplasia always remained severe, which confirms one of the leading roles of connective tissue pathology in the formation of medial abdominal hernias.

Relevance. Despite advances in the treatment of inguinal hernias are still being discussed, the issues of post-operative wound complications and disease recurrence. The inclusion in the list of risk factors for complicated postoperative course of systemic connective tissue dysplasia will allow a new look at the mechanisms of herniation in the groin area and develop morphologically adapted methods of surgical treatment. Objective. Study the characteristics of connective tissue dysmorphogenesis at hernia protrusions in the inguinal region. Results. In the main group absolutely reliable connection with all possible variants of hernia disease in the inguinal region possessed 6 (12 %) the morphological predictors, namely: dystonia dysfunction, curvature of the spine, hallus valgus, hypermobility joints, varicose disease of the lower limb and hemorrhoids. The curvature of a backbone and hyper mobility of joints occurred among manifestations of a dismorfizm at patients of control group. The area of electromyograms at reduction of muscles forming the torn down hernia the inguinal interval, on 20 % inferior area electromyograms reduction of similar muscles on contralateral from inguinal hernia to the side and on 61,4 % of area electromyograms contraction of the groin muscles of the control group patients. In a smaller proportion, but with similar characteristics reduced groups of lateral muscles, which is considered by us as local functional predictors of the implementation of systemic connective dysplasia in the hernia disease of the inguinal region. The density of the collagen fibers in the dermis of patients with inguinal hernias was 75.6 + 1.9%, which is 12,3 % lower than the result of such collagen metrics index of patients of the control group. Intensity of coloring of micropreparations of dermis of patients of control group was at the level of 36,33 + 2,1, that on 1,8 times less than this index in patients of the basic group. Conclusions. Thus, results of histology confirm reliability of the revealed morphological and local functional prerequisites of formation of inguinal hernias at connective dysplasia.

Introduction. Combined methods of hernioplasty appear to be a promising surgical treatment of inguinal hernias, allowing reducing suture tension due to the contraction and stretching of the abdominal muscles optimized during the operation. This protects the inguinal region from relapse in severe connective tissue dysplasia.The aim of research was to study the influence of the level of connective tissue dysplasia and methods of combined hernioplasty of inguinal hernias on the electroactivity of the abdominal muscles.Methods. The study included 151 patients with inguinal hernias. The electroactivity of the abdominal muscles and the level of severity of connective tissue dysplasia were studied in these patients before and after combined methods of hernioplasty according to Milkovskaya Dmitrova diagnostic scheme; this also includes tension-reducing mechanism.Results. In the preoperative period, the decrease in the parameters of electromyograms compared to the healthy side in the inguinal region was 67.2%, compared to the region over the group of lateral muscles - 55% and compared to the region over the rectus abdominis muscles - 23.6%. The increase in the electrical activity of the rectus muscles against the background of a decrease in the severity of connective tissue dysplasia to the middle and light levels obtained 43.5% and 77.9%, respectively.The average frequency parameters of electromyograms of the abdominal muscles after combined tension-reducing hernioplasty of inguinal hernias seemed to be most significant: in the inguinal regions on the side of the hernia they amounted to 91.95 7.1 vibrations per second, in the region over the group of lateral muscles - 94.61 4.6/s and in the region over the rectus abdominis muscles - 93.7 2.9/s. Moreover, approximately similar rehabilitation of the rectus and lateral abdominal muscles was reported, which allowed balancing oppositely directed tension forces in the abdominal wall.Conclusion. Thus, in patients with inguinal hernias before surgery, the decrease in the electroactivity of the lateral muscle group was more pronounced than the decrease in the electroactivity of the rectus abdominis. The combined tension-reducing hernioplasty of inguinal hernias contributed to the most significant electromyographic rehabilitation of the abdominal muscles.

Relevance. Improving the electrical function of abdominal muscles in patients with extensive median hernias of the anterior abdominal wall can be facilitated by optimizing the choice of methods for combined hernioplasty, taking into account the clinical severity of connective tissue dysplasia among the hernia carriers. Objective. Study the electrical function of abdominal muscles after the methods of combined hernioplasty of extensive median hernias, taking into account the severity of connective tissue dysplasia among the hernia carriers. Results.  The average numbers of electromyogram frequencies of the abdominal muscles of patients with extensive median hernias from the group without clinical signs of connective tissue dysplasia were almost the same after all the applied methods of combined hernioplasty. The predominance of the rectus muscles electric function over the lateral abdominal muscles among the patients of this group was 33,5 %. Electrofunctional rehabilitation of the abdominal muscles of patients in the second group of examinations depended on the method of combined hernioplasty and changed in the event of an increase or decrease in the severity of connective tissue dysplasia.  The recovery of electroactivity of abdominal muscles in the postoperative period in patients from the second group was more significant with an increase in the number of abdominal muscles applied to aponeuroses and vagina of relaxing sections, which contributed to an increase in mobility and contractility of the musculoaponeurotic layers of the anterior abdominal wall. Conclusions. Thus, with an increase in the severity of connective tissue dysplasia in patients with extensive median abdominal hernias, the method of combined hernioplasty with the most pronounced relaxing effect in relation to the anterior abdominal wall promoted optimal rehabilitation of abdominal muscles.