Abstract
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.
Highlights
There is no doubt that connective tissue insufficiency is involved in the recurrence of the disease after hernioplasty of median postoperative hernias [1,2,3,4,5]
At the others 32 (91,5%) patients with median postoperative hernias in microdrugs of the skin excised during operation the ratio of collagen changed aside or reduction of number of fibers with a direction corner to reference points of lines of Langer in the range of 0—20°, or increases in number of fibrous structures with other angles of orientation to lines of a tension that allowed to carry them in group of patients with histologically the confirmed level of a connective tissue dysplasia (Fig. 2)
Practically at all patients with median postoperative hernias disturbance of structure of a collagenic matrix in microdrugs in the form of change of normal orientation of collagen is revealed that confirmed value of a factor of a connective tissue dysplasia in the micropathological organization of an abdominal wall around median postoperative hernial defect
Summary
There is no doubt that connective tissue insufficiency is involved in the recurrence of the disease after hernioplasty of median postoperative hernias [1,2,3,4,5]. One of the most important aspects of postoperative herniogenesis in the midline of the abdomen is the “weakness” of the muscular aponeurotic framework of the anterior abdominal wall, which is manifested in the violation of contractile ability and in the reduction of the adaptive abilities of the abdominal muscles in relation to intra-abdominal pressure and leading to tissue overstretching and eruption of the hernia repair [9,10,11,12,13,14]. Electromyography compares the function of the abdominal muscles of patients with mid-postoperative hernias of different sizes before and after surgery, considering the level of connective tissue failure
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