Cofactorial herniotransformation peculiarities of midline abdomen

Abstract

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.