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

Abstract

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.

Keywords

prevention of incisional ventral hernias / laparotomy / suturing of the laparotomy wound / mesh endoprosthesis

References

[1] Protasov AV, Kalyakanova IO, Kaitova ZS. The Choice of Implant for Hernioplasty of Postoperative Ventral Hernias. RUDN Journal of Medicine. 2018;22(3):258-64. (In Russ). doi: 10.22363/2313-0245-2018-22-3-258-264

[2] Протасов А.В., Каляканова И.О., Каитова З.С. Выбор импланта для герниопластики вентральных грыж // Вестник РУДН. Серия: Медицина. 2018. Т. 22, № 3. C. 258-264. doi: 10.22363/2313-0245-2018-22-3-258-264

[3] Parshakov AA, Gavrilov VA, Samartsev VA. Prevention of complications of incisional hernia repair: current problem state (review). Sovremennye Tehnologii v Medicine. 2018;10(2):175-86. (In Russ). doi: 10.17691/stm2018.10.2.21

[4] Паршаков А.А., Гаврилов В.А., Самарцев В.А. Профилактика осложнений в хирургии послеоперационных грыж передней брюшной стенки: Современное состояние проблемы (обзор) // Современные технологии в медицине. 2018. Т. 10, № 2. С. 175-186. doi: 10.17691/stm2018.10.2.21

[5] Seo GH, Choe EK, Park KJ, et al. Incidence of Clinically Relevant Incisional Hernia After Colon Cancer Surgery and Its Risk Factors: A Nationwide Claims Study. World Journal of Surgery. 2018;42(4):1192-9. doi: 10.1007/s00268-017-4256-4

[6] Seo G.H., Choe E.K., Park K.J., et al. Incidence of Clinically Relevant Incisional Hernia After Colon Cancer Surgery and Its Risk Factors: A Nationwide Claims Study // World Journal of Surgery. 2018. Vol. 42, № 4. Р. 1192-1199. doi: 10.1007/s00268-017-4256-4

[7] Vnukov PV, Sheptunov YuM. Using the aponeurotic hypotensive suture in surgical treatment of patients with median postoperative ventral hernias. I.P. Pavlov Russian Medical Biological Herald. 2016;24(4):112-8. (In Russ). doi: 10.23888/PAVLOVJ20164112-118

[8] Внуков П.В., Шептунов Ю.М. Использование гипотензионного апоневротического шва в хирургическом лечении больных со срединными послеоперационными вентральными грыжами // Российский медико-биологический вестник имени академика И.П. Павлова. 2016. Т. 24, № 4. C. 112-118. doi: 10.23888/PAVLOVJ20164112-118

[9] Henriksen NA, Deerenberg EB, Venclauskas L, et al. Meta-analysis on Materials and Techniques for Laparotomy Closure: The MATCH Review. World Journal of Surgery. 2018;42(6):1666-78. doi: 10.1007/s00268-017-4393-9

[10] Henriksen N.A., Deerenberg E.B., Venclauskas L., et al. Meta-analysis on Materials and Techniques for Laparotomy Closure: The MATCH Review // World Journal of Surgery. 2018. Vol. 42, № 6. C. 1666-1678. doi: 10.1007/s00268-017-4393-9

[11] Oprea V, Radu VG, Moga D. Transversus Abdominis Muscle Release (TAR) for Large Incisional Hernia Repair. Chirurgia. 2016;111(6):535-40. doi: 10.21614/chirurgia.111.6.535

[12] Oprea V., Radu V.G., Moga D. Transversus Abdominis Muscle Release (TAR) for Large Incisional Hernia Repair // Chirurgia. 2016. Vol. 111, № 6. P. 535-540. doi: 10.21614/chirurgia.111.6.535

[13] Chalya PL, Massinde AN, Kihunrwa A, et al. Abdominal fascia closure following elective midline laparotomy: a surgical experience at a tertiary care hospital in Tanzania. BMC Research Notes. 2015;8:281. doi: 10.1186/s13104-015-1243-4

[14] Chalya P.L., Massinde A.N., Kihunrwa A., et al. Abdominal fascia closure following elective midline laparotomy: a surgical experience at a tertiary care hospital in Tanzania // BMC Research Notes. 2015. Vol. 8. P. 281. doi: 10.1186/s13104-015-1243-4

[15] Bellón JM, Pérez-López P, Simón-Allue R, et al. New suture materials for midline laparotomy closure: an experimental study. BMC Surgery. 2014;14:70. doi: 10.1186/1471-2482-14-70

[16] Bellón J.M., Pérez-López P., Simón-Allue R., et al. New suture materials for midline laparotomy closure: an experimental study // BMC Surgery. 2014. Vol. 14. P. 70. doi: 10.1186/1471-2482-14-70

[17] Spencer RJ, Hayes KD, Rose S, et al. Risk Factors for Early Occurring and Late-Occurring Incisional Hernias After Primary Laparotomy for Ovarian Cancer. Obstetrics and Gynecology. 2015;125(2):407-13. doi: 10.1097/AOG.0000000000000610

[18] Spencer R.J., Hayes K.D., Rose S., et al. Risk Factors for Early Occurring and Late-Occurring Incisional Hernias After Primary Laparotomy for Ovarian Cancer // Obstetrics and Gynecology. 2015. Vol. 125, № 2. P. 407-413. doi: 10.1097/AOG.0000000000000610

[19] Bharang KK, Jain A, Garg N. A clinical study of abdominal wound dehiscence and its management. IOSR Journal of Dental and Medical Sciences. 2018;17(2):69-72. doi: 10.9790/0853-1704176972

[20] Bharang K.K., Jain A., Garg N. A clinical study of abdominal wound dehiscence and its management // IOSR Journal of Dental and Medical Sciences. 2018. Vol. 17, № 2. P. 69-72. doi: 10.9790/0853-1704176972

[21] Fortelny RH. Abdominal Wall Closure in Elective Midline Laparotomy: The Current Recommendations. Frontiers in Surgery. 2018;5:34. doi: 10.3389/fsurg.2018.00034

[22] Fortelny R.H. Abdominal Wall Closure in Elective Midline Laparotomy: The Current Recommendations // Frontiers in Surgery. 2018. Vol. 5. P. 34. doi: 10.3389/fsurg.2018.00034

[23] Lebedev SN, Fedoseev AV, Inyutin AS, et al. Preventive surgical mash augmentation in middle laparotomy. Nauka Molodykh (Eruditio Juvenium). 2018;6(2):211-7. (In Russ). doi: 10.23888/HMJ201862211-217

[24] Лебедев С.Н., Федосеев А.В., Инютин А.С., и др. Превентивное эндопротезирование при срединных лапаротомиях // Наука молодых (Eruditio Juvenium). 2018. Т. 6, №2. С. 211-217. doi: 10.23888/HMJ201862211-217

[25] Sukovatykh BS, Valuĭskaia NM, Netiaga AA, et al. The influence of anatomical and functional failure of the abdominal wall on the prognosis of postoperative ventral hernias. Khirurgiya. 2014;(1):43-7. (In Russ).

[26] Суковатых Б.С., Валуйская Н.М., Нетяга А.А., и др. Влияние анатомо-функциональной недостаточности брюшной стенки на прогноз возникновения послеоперационных вентральных грыж // Хирургия. Журнал им. Н.И. Пирогова. 2014. № 1. C. 43-47.

[27] Brooks DC. Clinical features, diagnosis, and prevention of incisional hernias. UpToDate. 2019. Available at: https://www.uptodate.com/contents/clinical-features-diagnosis-and-prevention-of-incisional-hernias/print. Accessed: 2020 October 29.

[28] Brooks D.C. Clinical features, diagnosis, and prevention of incisional hernias // UpToDate. 2019. Available at: https://www.uptodate.com/contents/clinical-features-diagnosis-and-prevention-of-incisional-hernias/print. Accessed: 2020 October 29.

[29] Mizell JS. Principles of abdominal wall closure. UpToDate. 2019. Available at: https://www.uptodate.com/contents/principles-of-abdominal-wall-closure. Accessed: 2020 October 29.

[30] Mizell J.S. Principles of abdominal wall closure // UpToDate. 2019. Available at: https://www.uptodate.com/contents/principles-of-abdominal-wall-closure. Accessed: 2020 October 29.

[31] Fedoseev AV, Inyutin AS, Zhanygulov AD, et al. Comparative analysis of laparotomy closure techniques. Khirurgiya. 2017;(6):37-40. (In Russ). doi: 10.17116/hirurgia2017637-40

[32] Федосеев А.В., Инютин А.С., Жаныгулов А.Д., и др. Сравнительный анализ способов ушивания лапаротомной раны // Хирургия. Журнал им. Н.И. Пирогова. 2017. № 6. С. 37-40. doi: 10.17116/hirurgia2017637-40

RIGHTS & PERMISSIONS

Fedoseev A.V., Cherdanceva T.M., Inyutin A.S., Gluhovec I.B., Lebedev S.N., Murav'ev S.Y.