Abstract
Experimental evaluation of the abdominal wall healing in reoperations on the same surgical site, by means of macroscopic analysis, histological and breaking strength studies of the surgical scar. Twenty-four rats were selected and divided in 3 groups (G1, G2 and G3). A medium longitudinal laparotomy was performed, followed by laparorrhaphy on two synthesis planes, using an interrupted suture technique. The reoperations were performed in the same way, on the same surgical site. On the first day of the study all the 24 rats were operated, on the 30th day the 16 animals belonging to G2 and G3 were reoperated, and finally, on the 60th day, the 8 rats from G3 were operated for the third and last time. After 30 days of the last laparotomy of each group, euthanasia was performed. Complications such as adhesions were evaluated during the resection of surgical site. The breaking strength study was performed next, followed by the microscopical collagen analysis, using for that histological cuts stained with picrosirius. The adhesions were prevalent in G2 and G3 (16% each) when compared to G1. No significant difference was found in the breaking strength study. Statistically significant difference was observed in collagen concentration analysis. It was found higher mature collagen (type I) as well as total collagen concentration in the groups operated more than once (G2 and G3). The highest concentration of mature collagen (p<0,0001) and total collagen (p<0,0021) were found in G3 followed by G2 and G1 (in this sequence). The highest mature collagen concentration on the experimental groups, points out the importance of inflammatory activity in the healing process; in the resutures of the abdominal wall the surgical scar maturity is faster acquired than in the primary sutures; in relation to the primary sutures, the resutures of the abdominal wall did not influence in the resistance of the surgical scar.
Highlights
The laparotomies synthesis goals are: the recovery of continuity and the retrieval of muscleaponeurotic tensile strength able to restrain abdominal entrails in their domicile and the recovery of abdomen anatomic shape and abdominal wall function[1,2]
The goal of the current study is to experimentally evaluate abdominal wall healing, in reoperations at the same surgical site, by means of macroscopic analysis, histological and breaking strength studies of the surgical scar
The macroscopic analysis of the surgical wounds showed that 1 animal (4,16%) belonging to group 1 (G1) and 4 animals belonging to group 2 (G2) (16,66%) 4 to group 3 (G3) (16,66%) presented adhesions
Summary
The laparotomies synthesis goals are: the recovery of continuity and the retrieval of muscleaponeurotic tensile strength able to restrain abdominal entrails in their domicile and the recovery of abdomen anatomic shape and abdominal wall function[1,2]. Persistent bleeding is the main complication that requires an early new laparotomy; other relevant complications are: compartmental syndrome, intestinal obstruction, intra-abdominal abscesses, and peritonitis due to digestive sutures dehiscence[3]. It may still be used as programmed reoperation in cases of damage control (interruption of the operation before the hemorrhagic shock reaches its irreversible stage) for the definitive treatment of the lesions, removal of compresses and wall synthesis. The goal of the current study is to experimentally evaluate abdominal wall healing, in reoperations at the same surgical site, by means of macroscopic analysis, histological and breaking strength studies of the surgical scar
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