Topographic-Anatomic Justification of Various Methods Reducing Tissue Tension at Prosthetic Incisional Hernia Repair by «Sublay»

Abstract

Purpose. To develop a new relaxing incision on the anterior wall of rectus sheath and to compare its efficiency with the classical counterparts in the experiment.
 Materials and methods. We measured tension nodal seam with the help of a spring dynamometer on 24 cadavers. This seam was overlaid on the inner edge of the rectus abdominis in the region of the umbilical ring before and after relaxing incision. The objects of study were divided into four groups randomly. We studied the proposed wavelike relaxing incision in the first group and classical methods in other groups.
 Results. Maximum relaxation nodal seam (56%) was observed when using a wavelike relaxing incision of anterior wall of rectus sheath. Vertical relaxing incision of aponeurosis of the external oblique abdominal muscles along the lateral edge of the rectus abdominis (by O. M. Ramirez) was close in efficiency to the proposed method. It is possible to reduce tension of the nodal seam at 48%. Relaxing effect arc-shaped relaxing incision of anterior wall of rectus sheath by V.I. Belokonev was 39%. Vertical relaxing incision in a staggered pattern by U.Z. Zagirov showed minimal relaxing effect – 25%.
 Conclusion. Wavelike relaxing incision of anterior wall of rectus sheath which was proposed allows reducing tissue tension in hernioplasty compared to the classical methods.

Surgical Treatment Options for Patients with Large and Giant Postoperative Reducible Medial Abdominal Hernias

“…This method allowed restoring normal white-line anatomy, but was more traumatic due to tissue separation and partial violation of innervation; moreover, it required a larger-sized mesh prosthesis. (12) 3. Endoprosthetics of the anterior abdominal wall (with intramuscular placement of a mesh prosthesis) in the form of a "patch."…”

“…The method retained the existing pathological anatomy of the anterior abdominal wall and required a largesized mesh prosthesis. (11,12) In the experimental group, the IAP level was assessed using SpO 2 to validate the correctness of the plastic surgery option on Days 1, 2 and 7 after the operation.…”

“…(10) In the treatment of postoperative medial hernias, the "tension-free" technique of prosthetic abdominal wall hernia repair has become widely spread. (11,12) In large and giant postoperative hernias, a sharp increase in intra-abdominal pressure (IAP) resulting from immersing the hernia sac into the abdominal cavity and bringing the borders of the hernia orifice closer together appears to be a dangerous complication of hernioplasty in the postoperative period. Therefore, currently, the treatment of these patients must necessarily be accompanied by control of the magnitude and dynamics of IAP at various stages of treatment.…”